Chirurgie pour endométriose pelvienne profonde avant fécondation in vitro : pas de bénéfice pour la fertilité ?

Capelle A, A Capelle, J Lepage, Lepage J, C Langlois, Langlois C, C Lefebvre, Christine Lefebvre, Lefebvre C, D Dewailly, Didier Dewailly, Collinet P, P Collinet, Pierre Collinet, C Rubod, Chrystèle Rubod, Rubod C
Gynecologie, obstetrique & fertilite · 2015 · vol. 43(2) , pp. 109–116 · doi:10.1016/j.gyobfe.2014.12.003 · PMID:25595945 · W2062053833
article OA: closed CC0 ⤵ 26 in-corpus citations
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This study investigated the impact of surgical intervention for deep pelvic endometriosis prior to in vitro fertilization on fertility outcomes.

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Abstract

ObjectiveDoes surgery for deep infiltrating endometriosis (DIE) before in vitro fertilization (IVF) improve pregnancy and birth rate?Patients and methodsCohort study of 177 consecutive patients with DIE related infertility and receiving IVF. Patients were divided into 3 groups according to surgical management decided during multidisciplinary team meeting. Group no surgery (NS) (n=65), group complete surgery (CS) with complete resection of all lesions (n=49) and group incomplete surgery (IS) with gestures improving ovaries accessibility for IVF and/or facilitating embryonic implantation (n=63). Pre-surgery clinical, MRI lesion locations, and history of IVF characteristics were analyzed with logistic regression.ResultsThere was no significant difference in general and IVF characteristics and in the severity of endometriosis among the three groups (P=0.43). Overall pregnancy and birth rates after IVF were 45.8% and 33.3%, respectively and were not different among the 3 groups (P=0.59 and P=0.49). Four major complications during oocytes retrievals were observed in NS group, one in IS group and none in CS group. Presence of an inter-utero-rectal lesion at MRI decreased the rate of pregnancy (OR=0.49 [0.25, 0.97]).Discussion and conclusionsSurgery for deep infiltrating endometriosis does not improve pregnancy and birth rates before IVF. This inter-utero-rectal extensive lesion might explain IVF failures by ovarian difficult access and difficulties in embryonic transfers. Further studies should explore the impact of surgical excision of inter-utero-rectal lesion on oocyte retrieval and embryonic transfer.

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Condition tags

endometriosis

MeSH descriptors

Birth Rate Endometriosis Fertilization in Vitro Pregnancy Rate Adult Cohort Studies Endometriosis Endometriosis Female Humans Infertility, Female Infertility, Female Pregnancy

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