Fertility Outcomes After Laparoscopic Cystectomy in Infertile Patients with Stage III–IV Endometriosis: a Cohort with 6–10 years of Follow-up

Introduction Ovarian endometriosis is the most common type of endometriosis (EM), affecting more than 40% of women with EM. Currently, surgical intervention is still controversial in infertile patients with ovarian endometriosis, especially in those with stage III–IV EM. Very few studies have been done to analyze long-term pregnancy results in patients with endometrioma more than 5 years after surgery. Therefore, the aim of this study was to explore the pregnancy outcomes and the related factors in patients with endometrioma and stage III–IV endometriosis during a long-term follow-up postoperatively.

We collected 347 patients with ovarian endometriosis, which included 59 infertile patients with stage III–IV endometriosis who had a minimum of 5 years of postoperative follow-up after undergoing laparoscopic excision of ovarian endometriomas performed by a single doctor at the Peking Union Medical College Hospital from January 2009 to April 2013.

A total of 59 infertile patients were recruited. The mean age was 31.8 ± 3.6 years. The mean size of the endometriomas was 6.8 ± 3.3 cm. Before surgery, dysmenorrhea was present in 88.1% (52/59) of the cases, while chronic pelvic pain was reported in nine cases (15.3%). A total of 20.3% (12/59) of cases were concurrent with leiomyoma, 52.5% (31/59) with deep infiltrating endometriosis (DIE), and 39.0% (23/59) with adenomyosis. During laparoscopy, 21 cases were diagnosed as stage III (35.6%) and 38 as stage IV (64.4%) EM according to the revised American Fertility Society (AFS) classification. After laparoscopic cystectomy, 38 (64.4%) patients became successfully pregnant by the 5th year. All the patients were divided into two groups according to the postoperative pregnancy outcomes. In univariate analysis, the higher mean age and concurrent diagnosis of adenomyosis were seen to be related to poor postoperative pregnancy outcomes (p < 0.05). In multivariate analysis, however, the mean age, chronic pelvic pain (CPP), and adenomyosis were independent risk factors of pregnancy outcomes between the two groups (p < 0.05). With a minimum follow-up of 6 years, 23.7% (14/59) of recurrence was observed in the entire study cohort.

Infertile patients with endometrioma and stage III–IV EM may have lower pregnancy rates after laparoscopic cystectomy if they are older and present with CPP and adenomyosis. Our data showed a lower rate of recurrence but a higher rate of pregnancy after surgery. Similar content being viewed by others

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We appreciate the staff at the Peking Union Medical College Hospital for their diligent clinical work and precise data recording in the cases we reported in this article. We thank all the participants in the study. Funding Our work and the journal’s Rapid Service Fee were supported by the National Key R&D Program of China (No. 2017YFC1001200), National Natural Science Foundation of China (No. 81501237), and 2016 PUMCH Science Fund for Junior Faculty (No. PUMCH-2016-2.2). Authorship All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published. Authorship Contributions XY-L and JH-L developed the idea for the project. The study was designed by XY-L and TT-S, and SK-C, JJ-Z, Y-D, JH-S, SZ-J, and YS-W performed the data analysis and took full responsibility for the integrity of the data. TT-S, SK-C, and XY-L drafted the manuscript with inputs and critical discussion from JH-L and XY-L. The final version has been approved by all authors. Disclosures Ting-Ting Sun, Si-Kai Chen, Xiao-Yan Li, Jun-Ji Zhang, Yi Dai, Jing-Hua Shi, Shuang-Zheng Jia, Yu-Shi Wu, and Jin-Hua Leng have nothing to disclose. Compliance with Ethics Guidelines This study was approved by the Ethics Committee of Peking Union Medical College Hospital (JS-1722). This study was conducted in accordance with the Declaration of Helsinki. Written informed consent was obtained from all participants. Data Availability The datasets generated during and/or analyzed during the current study are available from the corresponding author upon reasonable request. Author information Authors and Affiliations Corresponding authors Additional information Digital Features To view digital features for this article go to https://doi.org/10.6084/m9.figshare.11968545. Rights and permissions About this article Cite this article Sun, TT., Chen, SK., Li, XY. et al. Fertility Outcomes After Laparoscopic Cystectomy in Infertile Patients with Stage III–IV Endometriosis: a Cohort with 6–10 years of Follow-up. Adv Ther 37, 2159–2168 (2020). https://doi.org/10.1007/s12325-020-01299-w Received: Published: Version of record: Issue date: DOI: https://doi.org/10.1007/s12325-020-01299-w