Endometriosis Associated Infertility

Women who fail to conceive spontaneously within 9-12 months of surgery for endometriosis-associated infertility should be entered into an IVF program, according to specialists.

The researchers from the Department of Gynaecology, Perinatology and Human Reproduction at the University of Florence, Italy, conducted a study to determine whether IVF and embryo transfer (IVF-ET) can significantly increase the overall pregnancy rate in infertile patients with endometriosis who did not conceive spontaneously after laparoscopic surgery (the ‘gold standard’ treatment for endometriosis).

They analyzed their center’s medical records to identify 154 women with infertility associated with endometriosis of at least 1 year’s duration who underwent laparoscopic surgery. After excluding women with additional factors affecting fertility, the final study group comprised 107 women with endometriosis-associated infertility. These women had been followed up for periods ranging from 1 year to 11 years.

Writing in a paper in the current issue of the European Journal of Obstetrics & Gynecology and Reproductive Biology, the researchers report that 40 of the 107 women (37.4 percent) achieved a spontaneous pregnancy.

The fecundity rate for spontaneous conception was found to be significantly higher in the 6 months immediately after laparoscopy (23.2 percent) than in subsequent time periods.

The remaining 67 women who did not become pregnant after surgery subsequently underwent IVF-ET, and 20 became pregnant (producing an overall pregnancy rate of 56.1 percent for the study group as a whole).

As expected from previous research findings, the likelihood of pregnancy was significantly higher in women with stage I or II endometriosis (70.2 percent overall) than in women with stage III or IV disease (45 percent overall). In addition, the pregnancy rate was significantly higher in women aged 35 years or younger (54.1 percent) than in women who were older than 35 years of age (23.2 percent).

The researchers write: “IVF-ET after surgery increased the overall probability of pregnancy (56.1 percent as compared with 37.4 percent for spontaneous pregnancies alone, p = 0.009)”.

They suggest in their paper that if, following laparoscopic surgery for endometriosis, spontaneous pregnancy does not occur within 9-12 months in women seeking to become pregnant, the women should be entered in an IVF-ET program. The researchers conclude: “When patients fail to conceive spontaneously, after a maximum of 1 year from laparoscopic surgery, IVF should be suggested.”