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Published on: January 22, 2022
Reproductive performance in infertile women with rectovaginal endometriosis: is surgery worthwhile?
Paolo Vercellini1, Giuliana Pietropaolo, Olga De Giorgi
1Benign Gynecologic Surgery Unit, Clinica Ostetrica e Ginecologica II, University of Milan, Istituto Luigi Mangiagalli, Milan, Italy.
Objective:
This study was undertaken to ascertain whether the incidence of pregnancy is increased and time-to-conception is reduced in infertile women with rectovaginal endometriosis undergoing conservative surgery compared with those on expectant management.
Study Design:
A total of 105 infertile women under the age of 40 years with rectovaginal endometriosis and no other associated major infertility factor underwent first-line conservative surgery at laparotomy or expectant management according to a shared decision-making approach.
Results:
Among the 44 women who had resection of rectovaginal endometriosis, 15 became pregnant, compared with 22 of the 61 women who choose expectant management (24-month cumulative probabilities, 44.9% and 46.8%, respectively; log-rank test, chi2(1) = 0.75; P = .38). One major and 9 minor postoperative complications occurred. Significant differences in pain-free survival time in favor of the surgery group were observed for dysmenorrhea, dyspareunia, and dyschezia.
Conclusion:
Conservative surgery for rectovaginal endometriosis in infertile women does not modify the reproductive prognosis although it does increase pain-free survival time.
