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. 2009 Mar-Apr;16(2):174-80.
doi: 10.1016/j.jmig.2008.12.009.

Extensive excision of deep infiltrative endometriosis before in vitro fertilization significantly improves pregnancy rates

Paulo H M Bianchi  1 , Ricardo M A Pereira, Alysson Zanatta, Jose Roberto Alegretti, Eduardo L A Motta, Paulo C Serafini
Affiliations

Extensive excision of deep infiltrative endometriosis before in vitro fertilization significantly improves pregnancy rates

Paulo H M Bianchi et al. J Minim Invasive Gynecol. 2009 Mar-Apr.

Erratum in

  • J Minim Invasive Gynecol. 2009 Sep-Oct;16(5):663

Abstract

Study objective: We sought to compare the outcomes of in vitro fertilization (IVF) treatments in women with infertility-associated deep infiltrative endometriosis (DIE) who underwent extensive laparoscopic excision of endometriosis before IVF with those who underwent IVF only.

Design: Prospective cohort study.

Setting: Infertility clinic and private hospital in São Paulo, Brazil.

Patients: A total of 179 infertile patients younger than 38 years had symptoms and/or signs of endometriosis and sonographic images suggestive of DIE.

Interventions: After thorough counseling, 179 women were invited to participate in a prospective cohort study with 2 treatment options: IVF without undergoing laparoscopic surgery (group A, n = 105) and extensive laparoscopic excision of DIE before IVF (group B, n = 64). Ten women were lost to follow-up. The IVF outcomes were compared between the 2 groups.

Measurements and main results: In group B, patients had 5 +/- 2 (mean +/- SD) DIE lesions excised during laparoscopy. Patient characteristics in groups A and B, respectively, were: age (32 +/- 3 vs 32 +/- 3 years, p = .94), infertility duration (29 +/- 20 vs 27 +/- 17 months, p = .45), day-3 serum follicle-stimulating hormone levels (5.6 +/- 2.5 vs 5.9 +/- 2.5 IU/L, p = .50), and previous IVF attempts (1 +/- 1 vs 2 +/- 1, p = .01). The IVF outcomes differed between groups A and B, respectively, with regard to total dose of recombinant follicle-stimulating hormone required to accomplish ovulation induction (2380 +/- 911 vs 2542 +/- 1012 IU, p = .01), number of oocytes retrieved (10 +/- 5 vs 9 +/- 5, p = .04), and pregnancy rates (24% vs 41%, p = .004), but not number of embryos transferred (3 +/- 1 vs 3 +/- 1, p = 1). The odds ratio of achieving a pregnancy were 2.45 times greater in group B than in group A.

Conclusion: Extensive laparoscopic excision of DIE significantly improved IVF pregnancy rates of women with infertility-associated DIE.

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