Impact of Laparoscopic Surgical Management of Deep Endometriosis on Pregnancy Rate

Study Objective: To evaluate the impact of laparoscopic excision of lesions on deep endometriosis-related infertility. Design: Retrospective study. Setting: Endometriosis tertiary referral center (Canadian Task Force II-2). Patients: A group of 115 patients who had undergone laparoscopic surgery for infertility with histologic confirmation of deep endometriosis. Interventions: Patient medical records and operative reports were reviewed. Telephone interviews were conducted for long-term follow-up of fertility outcomes. Measurements and Main Results: Evaluation of fertility outcome after laparoscopic treatment of deep endometriosis by spontaneous conception and by assisted reproductive technology (ART) correlated with lesion number, size, and location (anterior, posterolateral, pouch of Douglas, and multiple locations). After a mean follow-up of 22 months the overall pregnancy rate was 54.78% (n = 63) with a live-birth rate of 42.6% (n = 49). Among those patients given the chance to conceive spontaneously (n = 70), the overall pregnancy rate was 60% (n = 42): 38.5% (n = 27) spontaneously and 21.4% (n = 15) by ART. The removal of multiple lesions was associated with a higher pregnancy rate after surgery. When comparing isolated lesion size and disease location, there was no difference in pregnancy rate. Furthermore, those patients who underwent surgical eradication of the disease for the first time had a higher pregnancy rate (odds ratio, 4.18). Conclusion: This study demonstrates that laparoscopic excision of deep endometriosis enhances pregnancy rate, by both spontaneous conception and ART. First surgical treatment of multiple lesions was associated with higher pregnancy rates, whereas isolated lesions influenced the pregnancy rate irrespective of their location and size. © 2016 AAGL.