The benefit of adenomyomectomy on fertility outcomes in women with rectovaginal endometriosis with coexisting adenomyosis

Abstract

Study objective: To evaluate the effect of removal of coexisting adenomyosis on fertility outcomes in women with rectovaginal endometriosis.

Design: A retrospective cohort study.

Setting: A general hospital.

Patients: A total of 190 women who underwent laparoscopic nodule excision surgery for rectovaginal endometriosis between April 2007 and December 2012.

Interventions: Surgical excision of the rectovaginal endometriosis and coexisting uterine adenomyosis. Statistical analysis for fertility outcomes.

Measurement and main results: A total of 119 women desired postoperative pregnancy. Coexisting adenomyosis was found in 21% of the women. The overall clinical pregnancy rate was 41.2%. The only determining factor associated with a successful pregnancy was "age at surgery". Clinical pregnancy rates with or without adenomyosis were 36.0% and 42.6%, respectively. We found no significant difference in clinical pregnancy rates between the groups.

Conclusion: There is a possibility that surgical removal of coexisting adenomyosis positively effects fertility outcomes in women with rectovaginal endometriosis. However, it is also important to note that the age at surgery was a critical factor for successful pregnancy.

Keywords: adenomyosis; endometriosis; pregnancy; rectovaginal; surgery.

Figure 1

Adenomyosis coexisting with pelvic endometriosis. T2-weighted magnetic resonance image (sagittal section) of an adenomyosis coexisting with pelvic endometriosis. The adenomyosis localizes at the outer myometrium. The junctional zone is kept intact without aberrancy and the healthy muscular structures can be seen in between the adenomyosis and the junctional zone. This image was taken in a 32-year-old nulliparous woman.

Figure 2

Age distribution graphs. Age distributions of each group are shown. The total numbers of each age range and the numbers of women that succeeded in clinical pregnancy are indicated in parallel bar graphs. Preg = pregnancy.