EFFORT study: Surgery vs assisted reproductive technology among women with deep endometriosis – A multicenter randomized controlled trial

Maja Raos, Mikkel Seyer‐Hansen, Ulrik Schiøler Kesmodel, Ulla Breth Knudsen, Horace Roman
In: European Journal of Obstetrics & Gynecology and Reproductive Biology · 2026 · pp. 115350 · doi:10.1016/j.ejogrb.2026.115350 · W7172325090
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Abstract

Objective To compare surgery and assisted reproductive technology (ART) treatment on reproductive outcomes among women with rectosigmoid endometriosis. Design Multicenter, parallel-group, non-blinded, randomized controlled trial. Setting Women were enrolled from November 2020 to December 2023 at two tertiary endometriosis referral centers, either at the Department of Obstetrics and Gynecology in Aarhus, Denmark, or at IFEM Endo at Clinique Tivoli Ducos in Bordeaux, France. Participants Inclusion criteria were age between 18–38, diagnosis of rectosigmoid endometriosis, pregnancy intention of at least six months, a male partner, an acceptable anti-Müllerian hormone level (>5 pmol/L), and no more than two previous ART cycles. Interventions The women were randomly allocated to either surgery or ART with follow-up at nine and 18 months. Results 38 women were enrolled, 20 of whom were allocated to the ART group and 18 to the surgery group. After surgery, 61.1% (11/18) of the women became pregnant, of which 45.5% (5/11) occurred spontaneously. In parallel, 80.0% (16/20) became pregnant after ART with 31.3% (5/16) as spontaneous conceptions. Seven (38.9%) of the pregnancies resulted in live birth after surgery, and 13 (65.0%) after ART. No difference in these primary outcomes was observed between surgery and ART as treatment for endometriosis-associated infertility. Conclusion No significant difference in reproductive outcomes was revealed between surgery and ART among women with rectosigmoid endometriosis. However, the study population was small and underpowered, meaning the findings are uncertain and conclusions difficult to draw. The trial was registered at ClinicalTrials.gov (no. NCT04610710).

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