Surgery for endometriosis-associated infertility

A pragmatic approach

Paolo Vercellini, Edgardo Somigliana, Paola Viganò, Annalisa Abbiati, Giussy Barbara, Pier Giorgio Crosignani

Research output: Contribution to journalArticle

147 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)254-269
Number of pages16
JournalHuman Reproduction
Volume24
Issue number2
DOIs
Publication statusPublished - Feb 2009

Fingerprint

Endometriosis
Infertility
Pregnancy Rate
Morbidity
Therapeutics

Keywords

  • Endometriosis
  • Infertility
  • Laparoscopy
  • Pregnancy rates
  • Surgery

ASJC Scopus subject areas

  • Rehabilitation
  • Obstetrics and Gynaecology
  • Reproductive Medicine

Cite this

Surgery for endometriosis-associated infertility : A pragmatic approach. / Vercellini, Paolo; Somigliana, Edgardo; Viganò, Paola; Abbiati, Annalisa; Barbara, Giussy; Crosignani, Pier Giorgio.

In: Human Reproduction, Vol. 24, No. 2, 02.2009, p. 254-269.

Research output: Contribution to journalArticle

Vercellini, Paolo ; Somigliana, Edgardo ; Viganò, Paola ; Abbiati, Annalisa ; Barbara, Giussy ; Crosignani, Pier Giorgio. / Surgery for endometriosis-associated infertility : A pragmatic approach. In: Human Reproduction. 2009 ; Vol. 24, No. 2. pp. 254-269.
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