Does the Ovary Continue to Be the Most Common Site of Endometriosis in the Modern Laparoscopy Era? A Retrospective Chart Review of Diagnostic/Therapeutic Laparoscopies in Patients Diagnosed With Infertility

INTRODUCTION: The most common location of endometriotic implants in the pelvis has historically been documented as the ovary. High-definition video laparoscopy systems, uterine manipulators, among other tools, have since changed the process of diagnosing endometriosis. Few clinical studies in the modern laparoscopy era have been conducted with the objective of reviewing the most common location of endometriotic implants in an infertility population. OBJECTIVE: This study aimed to evaluate the most common site of endometriosis in patients with infertility. METHODS: A retrospective review of medical records from a reproductive endocrinology and infertility clinic, including subjects from January 2013 to June 2022, was performed. All patients presented with clinical diagnosis of infertility and elected to proceed with a diagnostic laparoscopy. Adjusted prevalence ratios (PR) for the binary outcome of moderate or severe endometriosis (vs. minimal or mild) were calculated from a log-binomial regression model. RESULTS: 276 patient charts were eligible for analysis. 223 (80.8%) subjects were Hispanic. Average age (SD) was 33 years (4.4), average BMI (SD) was 27.4 (4.7), 111 subjects (40.2%) were obese, and average length of infertility was 2.3 (1.4). Most patients had mild-moderate stage endometriosis: 11 (4%) had stage I, 182 (65.9%) had stage II, 54 (19.6%) had stage III, and 29 (10.5%) had stage IV. The most common sites of endometriosis were the ovarian fossa (87.7%), uterosacral ligament (57%), and the ovary (48%). Obesity was not associated with the presence of moderate or severe endometriosis (adjusted PR=0.89, 95% confidence interval [CI]: 0.61–1.29, p=0.53). Site of endometriosis (ovarian involvement vs. no ovarian involvement) was positively associated with moderate or severe endometriosis: adjusted PR=4.35, 95% CI: 2.66–7.12, p<0.0001). CONCLUSIONS: The most common site of endometriosis in this group of predominantly Hispanic patients diagnosed with infertility was not the ovary, but the ovarian fossa. Women with ovarian involvement were significantly more likely to have moderate or severe endometriosis.