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Reproductive outcome after treatment of mild endometriosis with laparoscopic excision and electrocoagulation
1Department of Obstetrics and Gynecology, McGill University, Royal Victoria Hospital, Montreal, Quebec, Canada. togas@rvhob2.lan.mcgill.ca
Objective:
To compare the pregnancy rates (PRs) of infertile women with mild endometriosis treated laparoscopically by surgical excision and by electrocoagulation. Laparoscopic treatment of minimal and mild endometriosis usually is done by laser or electrocoagulation. Whether surgical excision is associated with similar results is unknown.
Design:
Retrospective study with a historical control.
Setting:
University teaching hospitals.
Patient(S):
One hundred one infertile women undergoing laparoscopic treatment of mild endometriosis.
Intervention(S):
Forty-eight women were treated with electrosurgery (historical control) and 53 women were treated with excision.
Main Outcome Measure(S):
The PRs of the two groups of women were evaluated using life-table calculations and the Mantel-Cox test.
Result(S):
Of the total 24 pregnancies (PR: 57.1%) in the electrosurgery group, there were 3 spontaneous abortions (12.5%) and 1 ectopic pregnancy (4.2%). The total PR in the excision group was 53.5%, the abortion rate was 17.4% (4 of 23), and the ectopic PR was 8.7% (2 of 23). The median interval between surgery and conception was 10.7 months in the electrosurgery group and 13.3 months in the excision group. There was no statistically significant difference in the probability of conception between the two groups of women (Mantel-Cox test: z = 0.24). Using the Cox proportional-hazards model, the effects of age and duration of infertility were evaluated and were found not to be associated with a decreased PR.
Conclusion(S):
There is no difference in the PRs of infertile women with mild endometriosis treated laparoscopically by surgical excision and by electrocoagulation. The difference between these two modalities in women with endometriosis-related pelvic pain remains to be determined.