When to start ART after laparoscopic treatment of endometriosis?

The first 12 months after the surgery is the optimal time for pregnancy.

Key Points

Highlights: 

• The appropriate time interval for pregnancy to occur after laparoscopic surgery is the first 12 months postoperatively.
• After laparoscopic treatment of endometriosis, ART should be started after the first 12 months if the spontaneous pregnancy does not occur. 

Importance:

• The longer the time of infertility, the longer the interval between the operation and the pregnancy.

What's done here:

• This retrospective analysis describes a prospective follow-up of "endometriosis and infertility" patients to clarify the time interval of achieving pregnancy.
• Out of 695 women who underwent laparoscopic surgery, 102 patients were selected who were histologically confirmed for endometriosis and followed-up up to 16 years.
• They all had a desire for conception, with regular menstruation and a follicle-stimulating hormone level of less than 20 IU/ml.
• The data were collected through standardized questionnaires from the patients who could not get pregnant after at least 12 months of the surgery.
• Access to records of patients and data collection during follow-ups were carried out and results were statistically evaluated to find the highest pregnancy rate and the time interval starting the ART. 
• Subgroup analyses also were made according to their ages, BMI values, and stages of their disease related to rASRM.

Key Results:

• Among 102 participants, 71 became pregnant with 60 live births. Forty-nine pregnancies were with the help of ART, and 22 were conceived spontaneously.
• Long-term follow-up of the study showed a live-birth rate of 58,8%, but 42,2% had no successful pregnancy or delivery.
• The subgroups had no significant difference regarding BMI values and ages below or above 35.
• The cumulative pregnancy rates with or without ART related to rASRM stages. The median time until pregnancy was 8 months, and the optimal time to was the first 12 months. 

Lay Summary

Laparoscopy combined with histopathologic confirmation of endometriosis is the reference standard for diagnosing endometriosis. Additionally, laparoscopic surgery is considered the most effective way to approach infertility induced by endometriosis. The surgical factors influencing the outcome of treating the infertility of women with endometriosis are still controversial.

In their study, Tahmasbi Rad t al. from the Department of Obstetrics and Gynecology of the University of Frankfurt, Germany, aimed to find the factors that influence the time until pregnancy after the laparoscopic treatment of endometriosis. This article, in which they intended to find the appropriate time interval to start the ART, was recently published in the International Journal of Gynecology and Obstetrics.

Patients included in the study were diagnosed with 76,5 % primary infertility, 23,5% secondary infertility and had an immediate desire for conception. Hence the existence of endometriosis negatively affects spontaneous conceiving and pregnancy rate after ART treatment due to its inflammatory and immune modification effects on women; 38 months after the operation, the cumulative pregnancy rate remained at 69,8, meaning no further occurrence of pregnancies.

This long-follow-up study also evaluated cumulative pregnancy rates with or without ART related to rASRM stages. They found the median time until pregnancy was 8 months and considered the optimal time to achieve pregnancy after the surgery to be the first 12 months. Their results showed that ART could help patients regardless of their rASRM stages if complete treatment of visible lesions and fully restored anatomy have been achieved.

In conclusion, the authors recommended starting to try for pregnancy as soon as possible after the surgery. If conceiving is unsuccessful after 12 months, stages rASRM III and IV must begin ART. 

Research Source: https://pubmed.ncbi.nlm.nih.gov/37177870/