Reproductive Outcomes Following Minimally Invasive Surgery for Deep Endometriosis: A Cohort Study

Area of Science:

• Reproductive Medicine
• Surgical Oncology
• Gynecologic Surgery

Background:

• Deep endometriosis (DE) significantly impacts fertility.
• Surgical management of DE, especially with bowel involvement, requires careful consideration of reproductive outcomes.
• The Endometriosis Fertility Index (EFI) is a tool to predict fertility potential.

Purpose of the Study:

• To evaluate reproductive outcomes after fertility-sparing surgery for DE.
• To assess the impact of bowel resection on spontaneous conception rates.
• To determine the predictive value of the EFI for fertility success post-surgery.

Main Methods:

• Retrospective observational cohort study of 507 women with DE and infertility.
• Laparoscopic complete excision of endometriotic lesions with nerve-sparing techniques.
• Surgical strategies for bowel involvement included segmental resection, rectal shaving, and organ-sparing techniques.

Main Results:

• Overall pregnancy rate of 61.1% (310/507) with 70.3% spontaneous conceptions.
• Segmental bowel resection group achieved 91.2% pregnancy rate; rectal shaving group achieved 100%.
• Higher EFI scores predicted successful pregnancy (mean 5.5 vs. 4.9).

Conclusions:

• Nerve-sparing excision of DE, including bowel resection, yields high pregnancy rates.
• Surgery effectively restores natural fertility, decreasing the need for assisted reproductive technologies.
• Fertility-sparing surgery should be considered a primary treatment for women with DE desiring pregnancy.