Prevalence, characteristics, and management of endometriosis in an infertile Maltese population

Many women worldwide experience infertility as a result of endometriosis [1]. The present retrospective study aimed to determine the demographic, clinical, and laparoscopic characteristics of infertile Maltese women diagnosed with endometriosis, in addition to the type of treatment administered. Approval was obtained from the Research and Ethics Committee at the University of Malta, Msida, Malta. Data from hospital records of infertile Maltese women of reproductive age who underwent diagnostic laparoscopy at St Luke's Hospital and Mater Dei Hospital between September 1, 2003, and May 31, 2008, were compiled into a datasheet and inputted into PASW version 18 (SPSS, Chicago, IL, USA). Data were analyzed via χ2 test. P < 0.05 at a 95% confidence interval was considered to be statistically significant. Of the 437 patient files reviewed, endometriosis-associated infertility was diagnosed in 74 (16.9%) cases. These 74 patients (the average age of whom was 31 ± 4.03 years) constitute 0.138% of the female population of Malta. Fifty-four (73.0%) patients had primary infertility and 17 (23.0%) had secondary infertility, whereas the type of infertility was unknown in 3 (4.0%) cases. Other symptoms included dysmenorrhea (n = 38), dyspareunia (n = 11), and abdominal pain (n = 16). The mean age at menarche was 13 years, and most patients had regular menstrual cycles and menses. The stages of endometriosis were classified according to the American Society for Reproductive Medicine criteria [2] and noted as follows: minimal (n = 38); moderate (n = 6); severe (n = 4); and unspecified (n = 26). The most common sites of endometriosis were the pouch of Douglas (n = 16) and the uterosacral ligaments (n = 16). Thirty-four patients with minimal endometriosis did not receive any treatment. Of these 34 women, 16 achieved pregnancy. Ten of the 27 patients who were treated with a gonadotropin-releasing hormone (GnRH) agonist achieved pregnancy. Of the 5 women who underwent GnRH agonist treatment plus in vitro fertilization (IVF), 3 achieved pregnancy. In the 2 cases in which only IVF was performed, 1 pregnancy was achieved. A significant statistical relationship was found between the classification of endometriosis and the amount of menstrual flow (light, moderate, or severe): ν1 = 4, P = 0.007; χ2 = 14.018. When menstrual flow was moderate, endometriosis was minimal; when menstrual flow was heavy, endometriosis was severe. In conclusion, the characteristics of infertile Maltese women diagnosed with endometriosis are similar to those reported in the literature [1,3,4]. A relationship between the amount of menstrual flow and the classification of endometriosis was observed. In general, treatment strategies involve patients with minimal endometriosis receiving no treatment, or GnRH agonist treatment across the spectrum of endometriosis. The authors have no conflicts of interest.