Predictors for achieving pregnancy in patients with adenomyosis and endometriosis

Fertility after laparoscopic surgery for adenomyosis and endometriosis

Key Points

Highlights:

• Previous reports demonstrated that coexisting adenomyosis and endometriosis are common, and laparoscopic surgery is the main diagnostic and treatment method for both.
• But still, the pregnancy outcomes have to be studied.     

Importance:

• The present study aimed to clarify the effect of laparoscopic surgery on achieving pregnancy in patients with coexisting adenomyosis and endometriosis.

What's done here:

• Among 257 patients with fertility problems, 226 (87.94%) underwent laparoscopic surgery for coexisting adenomyosis and endometriosis and followed up at least two years.
• Diagnosis of adenomyosis is confirmed by ultrasonography with evaluating myometrial thickening, myometrial cysts, striations, hyperechoic islands, or irregular junctional zones.
• Diagnosis of endometriosis was made by histological confirmation of laparoscopically visualized endometriosis.
• Patients’ preoperative characteristics, operative data, and post-operative follow-up results were recorded. The endometriosis fertility index (EFI) was calculated.
• Women who had a successful delivery and women who had not were compared for preoperative data, operative parameters, and follow-up outcomes.

Key Results:

• Among 176 patients analyzed, 97 had a successful delivery (Group A) and 79 had not (Group B), were assumed as the two comparison groups.
• The patients in Group A were significantly younger and had a lower body mass index, had lower rates of anemia and FSH levels.
• Mean uterus diameter and mean cyst diameter was significantly higher in patients of Group B.
• Peritoneal endometriosis was significantly higher in Group A but ovarian endometriosis is significantly common in Group B.
• Multivariate regression analysis revealed that lower uterus diameter and endometriosis fertility index were significantly associated with live birth.

Limitations:

• The retrospective nature and relatively small patients’ number are limitations for the study.
• The data is from a single center and the study did not mention surgeon experience.
• The addition of third and fourth groups with laparotomy surgery and no surgery would have helped the results clearer.

Lay Summary

Adenomyosis and endometriosis are benign conditions, however, both situations are associated with deterioration of life quality, a requirement of hospital administrations, and infertility. Laparoscopic surgery is the main treatment option especially for women who desire pregnancy.

Shi and colleagues aimed to clarify possible factors for achieving successful birth following laparoscopic surgery in patients with coexisting adenomyosis and endometriosis.

The authors divided patients into two groups according to achieving successful birth; and found that the patients who had successful delivery following laparoscopic surgery were significantly younger and had a lower body mass index, lower anemia rate, and FSH levels. In contrast, mean uterus diameter and mean cyst diameter was significantly higher in patients who had not achieved successful delivery.

In addition, peritoneal endometriosis was significantly higher in patients who achieved successful birth, but ovarian endometriosis is significantly common in patients who had not achieved successful delivery.

Shi et al. stated that uterus diameter and endometriosis fertility index are the predictive factors for achieving successful birth in patients with coexisting adenomyosis and endometriosis following laparoscopy. The authors concluded that they hope their results would prove the use of surgery in patients who had endometriosis and adenomyosis together and open a window for further studies.

Research Source: https://pubmed.ncbi.nlm.nih.gov/34006232/