Hum. Reprod. Advance Access published online on April 8, 2009
Human Reproduction, doi:10.1093/humrep/dep083
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Laparoscopic treatment of bowel endometriosis in infertile women
1 Departments of Obstetrics and Gynecology, Ospedale Sacro Cuore, Via Don Sempreboni 5, 37024 Negrar, Verona, Italy 2 Department of General Surgery, Ospedale Sacro Cuore, Via Don Sempreboni 5, 37024 Negrar, Verona, Italy 3 Statistic Department, University of Verone, Verona, Italy
4 Correspondence address. E-mail: annastep{at}infinito.it
BACKGROUND: The purpose of the study was to determine the influence of bowel endometriosis on fertility, and to study whether its removal improves fecundity in women with endometriosis-associated infertility.
METHODS: Three groups of infertile patients were included in the study. Group A (60 women) consisted of patients who underwent surgery for endometriosis with colorectal segmental resection. In group B, 40 patients with evidence of bowel endometriosis underwent endometriosis removal without bowel resection. Group C consisted of 55 women who underwent surgery for moderate or severe endometriosis with at least one endometrioma and deep infiltrating endometriosis but without bowel involvement. The women were clinically evaluated before laparoscopy and then at 1 month, at 6 months and at each year up to 4 years after surgery. Main outcome measures were surgical complications as well as post-operative pregnancy rate, time to conception and monthly fecundity rate.
RESULTS: The monthly fecundity rates (MFR) in groups A, B and C were 2.3, 0.84 and 3.95%, respectively. The difference in the MFR between groups was significant (P < 0.05).
CONCLUSIONS: The presence of bowel infiltration by endometriosis seems to negatively influence the reproductive outcome in women with endometriosis-associated infertility. The complete removal of endometriosis with bowel segmental resection seems to offer better results in terms of post-operative fertility.
Key words: bowel endometriosis/infertility/pregnancy rates/laparoscopy/segmental bowel resection
Submitted on November 12, 2008; resubmitted on March 6, 2009; accepted on March 13, 2009.
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