Fertility and Infertility in Patients with Bowel Endometriosis

Bowel endometriosis is typically associated with deep endometriotic lesions in the pelvis and endometriomas, making it difficult to establish the precise impact of intestinal endometriotic lesions on fertility. Very limited data are available on rates of spontaneous conception in women with bowel endometriosis. Infertile patients with bowel endometriosis may either undergo surgery to enhance fertility or artificial reproductive techniques (ART) such as in vitro fertilization (IVF). Interpretation of the available data on fertility outcomes after colorectal surgery for deep endometriosis is difficult as the overall quality of the studies is poor. Furthermore, several studies do not distinguish patients with real infertility from those wishing to conceive without proven infertility. Patients with bowel endometriosis undergoing ART must be informed of the potential risks (e.g., bowel complications such as perforation and severe infection) during oocyte retrieval and pregnancy. Persistence of pelvic pain, intestinal symptoms due to delaying surgery as well as the progression of the degree of intestinal wall infiltration are well recorded. However, ART has some advantages in women with bowel endometriosis because it shortens the interval to conception and avoids the negative impact of postoperative complications (such as anastomotic leakage or deep pelvic abscess) on fertility. It is well established that bowel surgery leads to relief of pain and intestinal symptoms caused by endometriotic lesions. In contrast, the usefulness of bowel surgery to increase the likelihood of spontaneous conception is yet to be established. Access this chapter Tax calculation will be finalised at checkout Purchases are for personal use only Similar content being viewed by others

Darai E, Cohen J, Ballester M. Colorectal endometriosis and fertility. Eur J Obstet Gynecol Reprod Biol. 2017;209:86–94. Vercellini P, Vigano P, Frattaruolo MP, Borghi A, Somigliana E. Bowel surgery as a fertility-enhancing procedure in patients with colorectal endometriosis: methodological, pathogenic and ethical issues. Hum Reprod. 2018;33(7):1205–11. Roman H, Milles M, Vassilieff M, Resch B, Tuech JJ, Huet E, et al. Long-term functional outcomes following colorectal resection versus shaving for rectal endometriosis. Am J Obstet Gynecol. 2016;215(6):762e1–9. Roman H, Bubenheim M, Huet E, Bridoux V, Zacharopoulou C, Darai E, et al. Conservative surgery versus colorectal resection in deep endometriosis infiltrating the rectum: a randomized trial. Hum Reprod. 2018;33(1):47–57. Donnez O, Roman H. Choosing the right surgical technique for deep endometriosis: shaving, disc excision, or bowel resection? Fertil Steril. 2017;108(6):931–42. Nezhat C, Li A, Falik R, Copeland D, Razavi G, Shakib A, et al. Bowel endometriosis: diagnosis and management. Am J Obstet Gynecol. 2018;218(6):549–62. Leone Roberti Maggiore U, Scala C, Tafi E, Racca A, Biscaldi E, Vellone VG, et al. Spontaneous fertility after expectant or surgical management of rectovaginal endometriosis in women with or without ovarian endometrioma: a retrospective analysis. Fertil Steril. 2017;107(4):969–76.e5. Vercellini P, Pietropaolo G, De Giorgi O, Daguati R, Pasin R, Crosignani PG. Reproductive performance in infertile women with rectovaginal endometriosis: is surgery worthwhile? Am J Obstet Gynecol. 2006;195(5):1303–10. Ferrero S, Leone Roberti Maggiore U, Scala C, Tafi E, Venturini P, Racca A. Fertility in patients with untreated colorectal endometriosis. Fertil Steril. 2016;103(3):e-269–e70. Stepniewska A, Pomini P, Bruni F, Mereu L, Ruffo G, Ceccaroni M, et al. Laparoscopic treatment of bowel endometriosis in infertile women. Hum Reprod. 2009;24(7):1619–25. Acien P, Nunez C, Quereda F, Velasco I, Valiente M, Vidal V. Is a bowel resection necessary for deep endometriosis with rectovaginal or colorectal involvement? Int J Womens Health. 2013;5:449–55. Ballester M, d'Argent EM, Morcel K, Belaisch-Allart J, Nisolle M, Darai E. Cumulative pregnancy rate after ICSI-IVF in patients with colorectal endometriosis: results of a multicentre study. Hum Reprod. 2012;27(4):1043–9. Martin DC, Ling FW. Endometriosis and pain. Clin Obstet Gynecol. 1999;42(3):664–86. Ferrero S, Camerini G, Ragni N, Venturini PL, Biscaldi E, Seracchioli R, et al. Letrozole and norethisterone acetate in colorectal endometriosis. Eur J Obstet Gynecol Reprod Biol. 2010;150(2):199–202. Ferrero S, Camerini G, Ragni N, Venturini PL, Biscaldi E, Remorgida V. Norethisterone acetate in the treatment of colorectal endometriosis: a pilot study. Hum Reprod. 2010;25(1):94–100. Ferrero S, Camerini G, Venturini P, Biscaldi E, Remorgida V. Progression of bowel endometriosis during treatment with the oral contraceptive pill. Gynecol Surg. 2011;8(3):311–3. Ferrero S, Camerini G, Ragni N, Menada MV, Venturini PL, Remorgida V. Triptorelin improves intestinal symptoms among patients with colorectal endometriosis. Int J Gynaecol Obstet. 2010;108(3):250–1. Roman H, Friederich L, Khalil H, Marouteau-Pasquier N, Hochain P, Marpeau L. Treating severe endometriosis by pregnancy: a risky business. Gynecol Obstet Fertil. 2007;35(1):38–40. Govaerts I, Devreker F, Delbaere A, Revelard P, Englert Y. Short-term medical complications of 1500 oocyte retrievals for in vitro fertilization and embryo transfer. Eur J Obstet Gynecol Reprod Biol. 1998;77(2):239–43. Anaf V, El Nakadi I, Simon P, Englert Y, Peny MO, Fayt I, et al. Sigmoid endometriosis and ovarian stimulation. Hum Reprod. 2000;15(4):790–4. Roman H, Puscasiu L, Lempicki M, Huet E, Chati R, Bridoux V, et al. Colorectal endometriosis responsible for bowel occlusion or subocclusion in women with pregnancy intention: is the policy of primary in vitro fertilization always safe? J Minim Invasive Gynecol. 2015;22(6):1059–67. Setubal A, Sidiropoulou Z, Torgal M, Casal E, Lourenco C, Koninckx P. Bowel complications of deep endometriosis during pregnancy or in vitro fertilization. Fertil Steril. 2014;101(2):442–6. Leone Roberti Maggiore U, Ferrero S, Mangili G, Bergamini A, Inversetti A, Giorgione V, et al. A systematic review on endometriosis during pregnancy: diagnosis, misdiagnosis, complications and outcomes. Hum Reprod Update. 2016;22(1):70–103. Ferrero S, Anserini P, Abbamonte LH, Ragni N, Camerini G, Remorgida V. Fertility after bowel resection for endometriosis. Fertil Steril. 2009;92(1):41–6. Stepniewska A, Pomini P, Scioscia M, Mereu L, Ruffo G, Minelli L. Fertility and clinical outcome after bowel resection in infertile women with endometriosis. Reprod Biomed Online. 2010;20(5):602–9. Darai E, Carbonnel M, Dubernard G, Lavoue V, Coutant C, Bazot M, et al. Determinant factors of fertility outcomes after laparoscopic colorectal resection for endometriosis. Eur J Obstet Gynecol Reprod Biol. 2010;149(2):210–4. Darai E, Dubernard G, Coutant C, Frey C, Rouzier R, Ballester M. Randomized trial of laparoscopically assisted versus open colorectal resection for endometriosis: morbidity, symptoms, quality of life, and fertility. Ann Surg. 2010;251(6):1018–23. Darai E, Lesieur B, Dubernard G, Rouzier R, Bazot M, Ballester M. Fertility after colorectal resection for endometriosis: results of a prospective study comparing laparoscopy with open surgery. Fertil Steril. 2011;95(6):1903–8. Meuleman C, Tomassetti C, Wolthuis A, Van Cleynenbreugel B, Laenen A, Penninckx F, et al. Clinical outcome after radical excision of moderate-severe endometriosis with or without bowel resection and reanastomosis: a prospective cohort study. Ann Surg. 2014;259(3):522–31. Cohen J, Thomin A, Mathieu D'Argent E, Laas E, Canlorbe G, Zilberman S, et al. Fertility before and after surgery for deep infiltrating endometriosis with and without bowel involvement: a literature review. Minerva Ginecol. 2014;66(6):575–87. Malzoni M, Di Giovanni A, Exacoustos C, Lannino G, Capece R, Perone C, et al. Feasibility and safety of laparoscopic-assisted bowel segmental resection for deep infiltrating endometriosis: a retrospective cohort study with description of technique. J Minim Invasive Gynecol. 2016;23(4):512–25. Iversen ML, Seyer-Hansen M, Forman A. Does surgery for deep infiltrating bowel endometriosis improve fertility? A systematic review. Acta Obstet Gynecol Scand. 2017;96(6):688–93. Bendifallah S, Roman H, Mathieu d'Argent E, Touleimat S, Cohen J, Darai E, et al. Colorectal endometriosis-associated infertility: should surgery precede ART? Fertil Steril. 2017;108(3):525–31.e4. Ferrier C, Roman H, Alzahrani Y, d'Argent EM, Bendifallah S, Marty N, et al. Fertility outcomes in women experiencing severe complications after surgery for colorectal endometriosis. Hum Reprod. 2018;33(3):411–5. Hudelist G, Aas-Eng MK, Birsan T, Berger F, Sevelda U, Kirchner L, et al. Pain and fertility outcomes of nerve-sparing, full-thickness disk or segmental bowel resection for deep infiltrating endometriosis – a prospective cohort study. Acta Obstet Gynecol Scand. 2018;97(12):1438–46. Roman H. Colorectal endometriosis and pregnancy wish: why doing primary surgery. Front Biosci (Schol Ed). 2015;7:83–93. Barra F, Scala C, Biscaldi E, Vellone VG, Ceccaroni M, Terrone C, et al. Ureteral endometriosis: a systematic review of epidemiology, pathogenesis, diagnosis, treatment, risk of malignant transformation and fertility. Hum Reprod Update. 2018;24(6):710–30. Author information Authors and Affiliations Corresponding author Editor information Editors and Affiliations Rights and permissions Copyright information © 2020 Springer Nature Switzerland AG About this chapter Cite this chapter Ferrero, S., Watrelot, A., Grudzinskas, G. (2020). Fertility and Infertility in Patients with Bowel Endometriosis. In: Ferrero, S., Ceccaroni, M. (eds) Clinical Management of Bowel Endometriosis. Springer, Cham. https://doi.org/10.1007/978-3-030-50446-5_17 Download citation DOI: https://doi.org/10.1007/978-3-030-50446-5_17 Published: Publisher Name: Springer, Cham Print ISBN: 978-3-030-50445-8 Online ISBN: 978-3-030-50446-5 eBook Packages: MedicineMedicine (R0)