Determinant factors of fertility outcomes after laparoscopic colorectal resection for endometriosis

The aims of this prospective study were to evaluate fertility, pregnancy outcomes and their determinant factors after laparoscopic segmental colorectal resection for endometriosis.

We studied 83 women who underwent colorectal resection for endometriosis. Thirty-nine women (47%) had an associated infertility and 51 (61.4%) wished to conceive after surgery. Surgical route was exclusive laparoscopy in 77 cases (92.7%) and laparoconversion in 6 (7.3%).

Twenty-nine pregnancies were obtained in 24 patients (43.6%) including 20 spontaneous (69%) and 9 by IVF (31%). The median time to conceive spontaneously was 6 months and 20 months by IVF. Among the 39 infertile women, 18 (46%) conceived during the study period. A relation was found between pregnancy rate and patient age (p=0.02). Reduction in pregnancy rate was correlated to the presence of adenomyosis (p=0.04) and high ASRM total score (p<0.001) as well as exclusive laparoscopy compared to conversion to laparotomy for colorectal resection (p=0.01).

Adenomyosis and conversion to laparotomy as well as patient age, ASRM score appeared determinant factors of fertility outcome.