[Fertility outcomes following radical conservative laparoscopic endometriosis surgery in infertile patients]

Endometriosis affects 6%-15% of the female population of childbearing potential. Endometriosis has a wide range of symptoms. Infertility is one of the major and common consequences of endometriosis. Many treatment options are offered to the infertile patient - pharmacotherapy, dietary treatment, Assisted Reproductive Technology (ART), and surgery. Medical and dietary treatment alleviate symptoms, without improvement in pregnancy rates. Limited value of surgery is sometimes advocated, suggesting only ART improve pregnancy rates.

The aim of the study was to analyze the effectiveness of the surgical treatment of patients with endometriosis and infertility expressed in the number of pregnancies and the births.

The basis for the analysis was the prospectively updated database of patients with endometriosis undergoing surgical treatment, which included 768 records as of May 30, 2019. The analysis selected the period from 01/01/2013 to 31/12/2016, which treated 164 patients with endometriosis and sterility. 139 patients were qualified for the analysis. Most of the previously analyzed were treated for endometriosis and infertility (pharmacotherapy, surgery, ART-Assisted Reproductive Technology). All patients underwent standardized surgical treatment developed by the authors - radical conservative laparoscopic surgery. The analysis of pregnancies was performed for all patients jointly and according to the division according to the severity of the disease, including the methods of pregnancy (spontaneous pregnancy, ART). The analyzed group was divided according to the stage of endometriosis (IV - 40.3%, III - 21.6%, II - 26.6%, I - 11.5%), the majority being patients with symptoms of severe endometriosis (III + IV = 61.9%). Values of nominal variables were compared between groups with the chi-square test, and the Kruskal-Wallis test was used for measurable variables. As a statistical significance threshold, p <0.05 was accepted.

By May 2019, a total of 130 pregnancies in 101 cases were registered. There were 35 abortions, 95 live births (including 7 premature births) and 2 ongoing pregnancies. The percentage of pregnancies in the study group was 72.66%.

Pregnancy rate of 72.66% in the whole group and 70.93% in the group of advanced endometriosis is an encouraging and indicative result of radical conservative laparoscopic surgical treatment of endometriosis in patients with infertility.