Cumulative Pregnancy Rates Among Patients With Bowel Endometriosis According to Therapeutic Approach. A Systematic...

Area of Science:

• Reproductive Medicine
• Gynecologic Surgery
• Infertility Treatment

Background:

• Bowel endometriosis significantly impacts fertility.
• Limited data exists on cumulative pregnancy rates for various treatment options.

Purpose of the Study:

• To determine the cumulative pregnancy rates associated with different therapeutic strategies for bowel endometriosis-related infertility.
• To compare outcomes of expectant management, medically assisted reproduction, and surgical interventions.

Main Methods:

• Systematic review and meta-analysis of observational and randomized studies (2009-2025).
• Inclusion of 48 studies with 5963 patients diagnosed with bowel endometriosis.
• Quality assessment using the Newcastle-Ottawa scale; heterogeneity assessed with I², Chi², and Tau² statistics.

Main Results:

• Spontaneous cumulative pregnancy rate was 36% without surgery and 40% with first-line medically assisted reproduction.
• After primary surgery, cumulative pregnancy rates were 29% (spontaneous) and 56% (medically assisted reproduction).
• Overall pooled cumulative pregnancy rate after surgery was 56%; 24% for those with prior infertility post-surgery.

Conclusions:

• A patient-centered approach is recommended for managing bowel endometriosis-associated infertility.
• Combining surgical intervention with medically assisted reproduction is an effective strategy.
• Treatment decisions should be tailored to individual patient goals and symptom profiles.