Which treatment option improves fertility the most?

Let's Focus On This Unanswered Question: Tackling Infertility due to Endometriosis

Key Points

Importance:

• This mini-article by Drs. Pacheco and Mol aim to discuss an important question regarding the endometriosis and the importance of the question "Whether fertility is improved following surgery for endometriosis" along with its role in improving fertility.

Highlights:

• Authors are concerned that there are not enough randomized control studies regarding whether endometriosis surgery improves the fertility of women versus medical or expectant treatment for moderate/severe endometriosis. 
• Thus, they highlight that more funding and effort be put into developing such trials.

What’s done here:

• This is a mini-commentary discussing the lack of randomized-control studies comparing endometriosis surgery to medical and/or expectant management.

Key Results:

• Endometriosis is a condition that causes infertility in up to 30-50% of women that are affected.
• The Revised American Fertility Society classification of endometriosis (rAFS) does not predict fertility after endometriosis surgery but the endometriosis infertility index (EFI) was made in 2010 to address this issue. 
• The question of whether laparoscopic surgery is more effective than medical or expectant management for endometriosis is still not definitively answered due to a lack of randomized-control clinical studies. Most data are from observational studies.

- Authors suggest that a study that follows patients over a period of at least 6 or 12 months who were randomized into surgery and no surgery groups should be initiated.

Lay Summary

Endometriosis is a condition that causes anatomic, hormonal, and inflammatory disturbances that may ultimately result in decreased fertility or infertility. It is estimated that 30-50% of women with endometriosis suffer from infertility. Thus, the role of surgical, medical, or expectant management for patients with varying severity of endometriosis should be an active subject of research.

Unfortunately, definitive data from randomized-control studies comparing surgical, medical, and expectant management in women who wish to have the greatest chance of conceiving is lacking. Most research concerning the fertility effect of endometriosis surgery is from observational studies. There are several scores that have been made to address the severity of endometriosis and predict outcomes, however, they have several limitations.

The Revised American Fertility Society classification of endometriosis (rAFS) does not predict pregnancy rates after women with endometriosis are treated and is solely based on surgical findings. However, the Endometriosis Infertility Index (EFI) was made in 2010 to address this issue and is currently used to counsel women on their risk of fertility after surgery. Unfortunately, It does not answer whether different treatment options are better than the other. Thus, the authors believe and suggest that studies following patients over a period of at least 6 or 12 months randomized into either surgery and no surgery groups should be planned to answer this question and that more funding be allocated for clarifying this issue. 

Research Source: https://www.ncbi.nlm.nih.gov/pubmed/31599101