Should I Have Surgery Before Trying to Conceive?

The answer might be yes in the case of posterior deep endometriosis if rectouterine nodules are present.

Key Points

Highlights:

• The presence of rectovaginal nodules could be a factor in lowering the chances of a woman with deep pelvic endometriosis getting pregnant using in vitro fertilization (IVF)

Importance:

• It is not well-known whether surgery before IVF is beneficial for fertility. No benefit was shown by some authors, while other studies have shown that colorectal resection improved fertility

What's done here:

• This retrospective observational single-center study included patients for infertility related to posterior deep endometriosis, who had one or two IVF attempts. Patients with isolated anterior deep endometriosis, those who need egg donation, endometriosis operated between the first two IVF attempts were excluded. The study was limited to the first two IVF attempts.

• The deep endometriosis was diagnosed h by MRI and confirmed by laparoscopy with pathological examinations. 

• A large set of variables and their association with the chance of an infertile woman with endometriosis of getting pregnant were analyzed.

Key results:

• Five variables were identified that are significantly associated with the chance of an infertile woman with endometriosis getting pregnant. They are the number of oocytes retrieved, age, the number of single embryos transferred, the IVF technique used, and the presence of recto uterine nodules.
• This is the first study that identifies rectovaginal nodules as a factor lowering the chance of getting pregnant in infertile women with endometriosis. 

Limitations:

• The study only looked at the outcome of IVF and did not consider spontaneous pregnancies.
• The impact of surgery on the symptoms of endometriosis was not considered in the study.
• All stages of endometriosis were studied but women included in the study consisted mostly of women with stages 3 and 4 endometriosis.

Lay Summary

The presence of rectouterine nodules is associated with a lower chance of becoming pregnant with in vitro fertilization (IVF), according to a study published in the Journal of Gynecology Obstetrics and Human Reproduction. This finding is important as it can allow healthcare professionals to offer better counseling to patients with deep pelvic endometriosis.

Endometriosis is associated with infertility in 30-50 percent of cases. IVF is commonly used to treat infertile women with endometriosis but the technique is not always successful.

A team of researchers in France wanted to evaluate the factors affecting the outcome IVF treatment in infertile women with posterior deep endometriosis. So they conducted a retrospective study that included 230 women who were referred to Lille Regional University Hospital for infertility due to posterior deep endometriosis, between January 1, 2007, and September 30, 2013. All women had already had one or two IVF attempts. Almost half of them (48.7 percent) achieved a pregnancy after two IVF attempts.

The researchers identified five variables that were significantly associated with the women’s chance of getting pregnant. These were the number of oocytes retrieved, the age of the woman, the number of single embryos transferred, the IVF technique used, and the presence of recto uterine nodules.

This is the first study that identified rectouterine nodules as a factor lowering the chance of getting pregnant. According to the authors, surgery before IVF treatment may increase the chances of a woman with deep endometriosis getting pregnant using the technique. However, the surgery itself may have associated risks and more studies are needed to confirm this hypothesis.

In fact, two related studies on this subject were summarized in Endonews very recently for our readers.

Research Source: https://www.ncbi.nlm.nih.gov/pubmed/29908951