Laparoscopic surgical correction of endometriosis improves fertility rates in infertile patients: a retrospective analysis of 119 cases

Prakash Parmar, Avani Kannar, Rukesh Ghodasara, Sweta Patel
In: International Journal of Reproduction, Contraception, Obstetrics and Gynecology · 2024 · vol. 13(3) , pp. 675–678 · doi:10.18203/2320-1770.ijrcog20240475 · W4392772682
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Laparoscopic removal of endometriomas, nodules, and posterior peritonectomy improved fertility rates in 70.4% of infertile patients with endometriosis.

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This retrospective analysis evaluated 119 infertile patients with endometriosis who underwent laparoscopic surgical correction consisting of removal of endometriomas, nodules, and total posterior compartment peritonectomy at a single hospital/IVF center from May 2021 to April 2023, with pregnancy as the primary outcome. After excluding 11 lost to follow-up, 108 patients were analyzed, and 70.4% conceived within one year of surgery, including 44.7% with spontaneous conception and the remainder using ovulation induction ± IUI or IVF. The paper reports that 95% of patients experienced relief of dysmenorrhea and dyspareunia after surgery, but it provides no control group and notes loss to follow-up as a limitation. This paper is centrally about endometriosis — it evaluates how laparoscopic excision including total posterior compartment peritonectomy affects fertility outcomes in endometriosis-related infertility.

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Abstract

Background: Endometriosis is a common cause of infertility, affecting up to 50% of women with infertility. Surgery is a widely used treatment option for endometriosis, and the removal of endometriomas, nodules, and total posterior compartment peritonectomy has been shown to improve fertility rates in affected patients. The aim of the present study was to evaluate the role of laparoscopic surgical correction of endometriosis by removal of endometriomas, nodules, and total posterior compartment peritonectomy in improving rates of fertility in patients with endometriosis. Methods: A retrospective analysis of 119 patients who underwent laparoscopic surgical correction of endometriosis for infertility between May 2021 and April 2023 at Venus Women’s Hospital and IVF Center, Rajkot, India, was conducted. Inclusion criteria were documented endometriosis confirmed on Ultrasound and/or laparoscopy or accidentally detected during laparoscopy. All patients underwent laparoscopy for diagnosis confirmation. The primary outcome was pregnancy. Results: A total of 119 patients with endometriosis-related infertility were included in the study. Of the 119 patients who underwent laparoscopic surgical correction of endometriosis, 11 were lost to follow-up, leaving 108 patients for analysis. Of these, 76 patients (70.4%) conceived within one year of surgery. Of those who conceived, 34 (44.7%) did so spontaneously, without any medical treatments. A total of 42 patients (55.3%) conceived with ovulation induction only or ovulation induction with intrauterine insemination (IUI). Twenty-two patients (28.9%) underwent in vitro fertilization (IVF) and conceived, while 10 (13.2%) did not conceive with the first cycle of IVF and were still undergoing infertility treatment. The majority of patients (95%) reported relief of dysmenorrhea and dyspareunia after surgery. Conclusions: Study suggests that laparoscopic surgical correction of endometriosis by removal of endometriomas, nodules, and posterior peritonectomy can improve rates of fertility in patients with endometriosis-related infertility. The procedure was also found to be effective in relieving pain symptoms in most patients.
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Background

Endometriosis is a common cause of infertility, affecting up to 50% of women with infertility. Surgery is a widely used treatment option for endometriosis, and the removal of endometriomas, nodules, and total posterior compartment peritonectomy has been shown to improve fertility rates in affected patients. The aim of the present study was to evaluate the role of laparoscopic surgical correction of endometriosis by removal of endometriomas, nodules, and total posterior compartment peritonectomy in improving rates of fertility in patients with endometriosis.

Methods

A retrospective analysis of 119 patients who underwent laparoscopic surgical correction of endometriosis for infertility between May 2021 and April 2023 at Venus Women’s Hospital and IVF Center, Rajkot, India, was conducted. Inclusion criteria were documented endometriosis confirmed on Ultrasound and/or laparoscopy or accidentally detected during laparoscopy. All patients underwent laparoscopy for diagnosis confirmation. The primary outcome was pregnancy.

Results

A total of 119 patients with endometriosis-related infertility were included in the study. Of the 119 patients who underwent laparoscopic surgical correction of endometriosis, 11 were lost to follow-up, leaving 108 patients for analysis. Of these, 76 patients (70.4%) conceived within one year of surgery. Of those who conceived, 34 (44.7%) did so spontaneously, without any medical treatments. A total of 42 patients (55.3%) conceived with ovulation induction only or ovulation induction with intrauterine insemination (IUI). Twenty-two patients (28.9%) underwent in vitro fertilization (IVF) and conceived, while 10 (13.2%) did not conceive with the first cycle of IVF and were still undergoing infertility treatment. The majority of patients (95%) reported relief of dysmenorrhea and dyspareunia after surgery.

Conclusions

Study suggests that laparoscopic surgical correction of endometriosis by removal of endometriomas, nodules, and posterior peritonectomy can improve rates of fertility in patients with endometriosis-related infertility. The procedure was also found to be effective in relieving pain symptoms in most patients. Metrics

References

Smolarz B, Szyłło K, Romanowicz H. Endometriosis: epidemiology, classification, pathogenesis, treatment and genetics. Int J Mol Sci. 2021;22(19):10554. Kanno K, Andou M, Aiko K, Yoshino Y, Sawada M, Sakate S, et al. Fertility-and nerve-sparing laparoscopic eradication of deep endometriosis with total posterior compartment peritonectomy: the Kurashiki method. J Minimal Inva Gynecol. 2021;28(2):170-1. American Society for Reproductive Medicine. Revised American Society for Reproductive Medicine classification of endometriosis. Fertil Steril. 1997;67(5):817-21. Farquhar C. Endometriosis. BMJ. 2007;334(7587):249-53. Lee SY, Koo YJ, Lee DH. Classification of endometriosis. Yeungnam Univ J Med. 2021;38(1):10-18. Tuttlies F, Keckstein J, Ulrich U, Possover M, Schweppe KW, Wustlich M, et al. ENZIAN-score, a classification of deep infiltrating endometriosis. Zentralbl Gynakol. 2005;127(5):275-81. Forschung SE. 6th Conference of the Stiftung Endometriose Forschung (Foundation for Endometriosis Research); 2010 Feb 19–21; Weissensee, Austria. Weissensee: Stiftung Endometriose Forschung. 2010. Forschung SE. The revised Enzian classification. Consensus meeting. In7th Conference of the Stiftung Endometriose Forschung (Foundation for Endometriosis Research), Hotel Enzian, Weissensee, Austria. Vol. 2011. In: Weissensee, Austria: Stiftung Endometriose Forschung (SEF); 2011. Johnson NP, Hummelshoj L, World Endometriosis Society Montpellier Consortium, Abrao MS, Adamson GD, Allaire C, et al. Consensus on current management of endometriosis. Human Reproduct. 2013;28(6):1552-68. Guo SW, Mao X, Yan Y. Surgery versus expectant management for infertility in endometriosis: a systematic review and meta-analysis. Fertil Steril. 2021;116(2):267-76. Gordts S, Koninckx P, Brosens I. Pathogenesis of deep endometriosis. Fertil Steril. 2017;108(6):872-85. Chiminacio I, Obrzut C, Saggin S. Post-orgasm pain associated with endometriosis and complete resolution of symptoms after laparoscopic en-bloc peritonectomy, a case report. Int J Surg Case Rep. 2023;109:108558. Dückelmann AM, Taube E, Abesadze E, Chiantera V, Sehouli J, Mechsner S. When and how should peritoneal endometriosis be operated on in order to improve fertility rates and symptoms? The experience and outcomes of nearly 100 cases. Arch Gynecol Obstet. 2021;304(1):143-55.

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endometriosisdysmenorrheadyspareuniainfertility

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