Effectiveness of Laparoscopic Evaluation of Women with Previous Endometriosis Surgery for Improving Fertility

Background: Endometriosis is a common and important health problem of women. This exact prevalence is unknown because surgery is required for it's diagnosis. Endometriosis is more prevalent in the setting of infertility, with proper patient selection, a meticulously preformed laparoscopic, surgery is an excellent option that provides these patients to achieve repeated future pregnancies. Objective: Laparoscopic evaluation of previous open or laparoscopy surgery in women with all stage of endometriosis for improving fertility. Methods: Khulna medical college (KMC) and Victory endoscopic center based cross sectional descriptive study was performed in 2008 -2016 in 200 cases for laparoscopic assessment and management of pelvic endometriosis with infertility. Criteria for performing laparoscopy was as follows: after initial laparoscopy or open surgery no improvement of pelvic pain, no improvement of fertility or no improvement of dysmenorhoea, dyspareunia and/or recurrence of chocolate cyst. Exclusion criteria's were age above 40 years and Low AMH or ovarian reserve. Results: Within 200 cases, the age ranges from 25 -40 years and period of infertility less then 3 years about 39% and more than 61%. Primary infertility was 85% and secondly infertility was 15%. Within 200 cases open surgery were 109 and laparoscopy were 91 cases and the documentation of previous surgeries were stage I endometriosis, 5.5%, stage -II 26.5%, stage III 33% and stage -IV 19.5%, documentation was lost in 15.5%. The surgeries which we had done reconstinction of pelvic anatomy and cystectomy but 8 patients were quired total abdominal hysterectomy and bilateral salphingeatomy due to frozen pelvis. 11 patient's were referred to IVF and ET centre. Within these cases our achieved pregnancy rate was about 31% & rest are under observation. Conclusion: Relaparoscopy gives beneficial result if in young patient with good ovarian reserve. IVF treatment is definitely a suitable option for older patients and after 1 st time surgery. But exclusion of age and ovarian reserve, 2 nd time laparoscopic management is beneficial where limited facilities for IVF and ET.