Colorectal endometriosis and pregnancy wish why doing primary surgery

Horace Roman, Roman H
Frontiers in bioscience (Scholar edition) · 2015 · vol. 7(1) , pp. 83–93 · doi:10.2741/s426 · PMID:25961688 · W2343267102
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⚙ AI-generated summary by claude@2026-06, 2026-06-11 ⓘ

This paper reviews management options for colorectal endometriosis in women desiring pregnancy, comparing primary surgery versus assisted reproductive technology and discussing potential risks of delayed surgical intervention.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-11 · read from full text ⓘ

This review discusses management debates for patients with colorectal endometriosis who wish to become pregnant, focusing on whether primary surgical excision should be done versus IVF first (and later surgery if needed). Drawing on published nonrandomized evidence, it reports that primary IVF strategies have pregnancy rates below 45% and cumulative rates up to 68% across as many as three IVF cycles, while primary surgery reports pregnancy rates above 60%, including spontaneous conception in up to 60% of pregnancies. It highlights an unresolved concern that delaying surgery for months or years could worsen outcomes via risks such as bowel obstruction, greater need for radical colorectal procedures, higher postoperative morbidity, and prolonged painful complaints, but notes that definitive conclusions require large international randomized trials with over 400 participants and multi-year follow-up. This paper is centrally about endometriosis — it is a review focused specifically on colorectal deep endometriosis in the context of fertility and the decision for primary surgery when pregnancy is desired.

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Abstract

One of the most interesting debates surrounding deep endometriosis concerns the management of patients with colorectal lesions and pregnancy intention, for which no strong first level of evidence data exists to recommend performing surgical excision of colorectal endometriosis or ART. Studies assessing the policy of primary IVF have recorded pregnancy rates inferior to 45% and estimated cumulative pregnancy rates after up to 3 cycles or IVF as high as 68%. Other authors have reported pregnancy rates over 60% in patients undergoing primary surgery for colorectal endometriosis, with spontaneous conception representing up to 60% of pregnancies. Although overall pregnancy rates appear roughly comparable in patients undergoing either IVF followed by surgery or surgery followed if required by IVF, questions remain as to whether delaying surgery for months or years impairs health. Delaying surgery may lead to bowel occlusion, higher rates of radical colorectal procedures, increased postoperative morbidity and prolonged painful complaints. To provide definitive answers requires a randomized trial on an international scale with a sample size exceeding 400 patients and follow up averaging 4 years.
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Abstract

One of the most interesting debates surrounding deep endometriosis concerns the management of patients with colorectal lesions and pregnancy intention, for which no strong first level of evidence data exists to recommend performing surgical excision of colorectal endometriosis or ART. Studies assessing the policy of primary IVF have recorded pregnancy rates inferior to 45% and estimated cumulative pregnancy rates after up to 3 cycles or IVF as high as 68%. Other authors have reported pregnancy rates over 60% in patients undergoing primary surgery for colorectal endometriosis, with spontaneous conception representing up to 60% of pregnancies. Although overall pregnancy rates appear roughly comparable in patients undergoing either IVF followed by surgery or surgery followed if required by IVF, questions remain as to whether delaying surgery for months or years impairs health. Delaying surgery may lead to bowel occlusion, higher rates of radical colorectal procedures, increased postoperative morbidity and prolonged painful complaints. To provide definitive answers requires a randomized trial on an international scale with a sample size exceeding 400 patients and follow up averaging 4 years.

Keywords

- Deep Endometriosis - Colorectal Endometriosis - Fertility - Infertility - IVF - Surgery - Complications - Review

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Condition tags

endometriosis

MeSH descriptors

Colonic Diseases Endometriosis Rectal Diseases Colonic Diseases Colonic Diseases Colonic Diseases Endometriosis Endometriosis Endometriosis Female Humans Pregnancy Randomized Controlled Trials as Topic Rectal Diseases Rectal Diseases Rectal Diseases Sperm Injections, Intracytoplasmic

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