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Hum. Reprod. Advance Access published online on October 23, 2008
Human Reproduction, doi:10.1093/humrep/den379
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© The Author 2008. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Opinion

Surgery for endometriosis-associated infertility: a pragmatic approach

Paolo Vercellini1,3,4, Edgardo Somigliana2,3, Paola Viganò3, Annalisa Abbiati1,3, Giussy Barbara1 and Pier Giorgio Crosignani1

1 Gynaecologic Surgery Division, Department of Obstetrics and Gynaecology, University of Milan, via Commenda 12, 20122 Milano, Italy 2 Infertility Unit, Fondazione Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, Istituto "Luigi Mangiagalli", Via Commenda 12, 20122 Milano, Italy 3 Center for Research in Obstetrics and Gynaecology (C.R.O.G.), viale Caldara 39, 20122 Milan, Italy

4 Correspondence address. Clinica Ostetrica e Ginecologica I Istituto "Luigi Mangiagalli" Università di Milano Via Commenda, 12 -, 20122 Milan, Italy. Tel: +39-02-5503-2917; Fax: +39-02-5503-2331; E-mail: paolo.vercellini{at}unimi.it

Laparoscopic treatment for endometriosis-associated infertility is gaining widespread popularity supported mostly by uncontrolled studies, but the purported benefit of surgery may be overvalued. We have therefore analysed the best available evidence with the aim of defining an approximate estimate of the effect size of conservative surgery for infertile women with endometriosis in various clinical conditions. The overall increase in post-operative likelihood of conception over background pregnancy rate may be estimated to be between 10 and 25%. The effect of surgery for peritoneal lesions is limited, and an estimate of benefit should be decreased by the fact that preoperative identification of the subjects actually with the condition is unfeasible. The benefit of excision of ovarian endometriomas is difficult to define due to multiple confounding factors and methodological drawbacks in the considered studies. Excision of rectovaginal endometriosis is of doubtful value and associated with worrying morbidity. The role of surgery before, after or as an alternative to IVF needs clarification. In conclusion, the absolute benefit increase of surgery for endometriosis-associated infertility appears smaller than previously believed. Complete and detailed information on risks and benefits of treatment alternatives must be offered to infertile patients to allow unbiased choices between possible options.

Key words: endometriosis/infertility/surgery/laparoscopy/pregnancy rates

Submitted on August 4, 2008; resubmitted on September 22, 2008; accepted on September 24, 2008.


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P. Vercellini, P. G. Crosignani, E. Somigliana, N. Berlanda, G. Barbara, and L. Fedele
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[Abstract] [Full Text] [PDF]


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