Surgery for endometriosis-associated infertility: a pragmatic approach
Abstract
Laparoscopic treatment for endometriosis-associated infertility is gaining widespread popularity supported mostly by uncontrolled studies, but the purported benefit of surgery may be overvalued. We have therefore analysed the best available evidence with the aim of defining an approximate estimate of the effect size of conservative surgery for infertile women with endometriosis in various clinical conditions. The overall increase in post-operative likelihood of conception over background pregnancy rate may be estimated to be between 10 and 25%. The effect of surgery for peritoneal lesions is limited, and an estimate of benefit should be decreased by the fact that preoperative identification of the subjects actually with the condition is unfeasible. The benefit of excision of ovarian endometriomas is difficult to define due to multiple confounding factors and methodological drawbacks in the considered studies. Excision of rectovaginal endometriosis is of doubtful value and associated with worrying morbidity. The role of surgery before, after or as an alternative to IVF needs clarification. In conclusion, the absolute benefit increase of surgery for endometriosis-associated infertility appears smaller than previously believed. Complete and detailed information on risks and benefits of treatment alternatives must be offered to infertile patients to allow unbiased choices between possible options.
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Surgery improves the chances of natural conception in endometriosis.
“Numerous reports have concurred to indicate that surgery enhances the chances of natural conception (32).”
From Endometrial receptivity in adenomyosis and/or endometriosis (2023) · cites this paper as [32]
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Endometriosis: pathogenesis and treatment
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“While surgical therapy was considered the main intervention for many years, it must now be recognized and accepted that repeated surgery does not guarantee long-term improvement concerning the patient’s desire to have children [9] nor regarding pain reduction.”
BackgroundSurgery for Deep Endometriosis: A Pathogenesis-Oriented Approach
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The Impact of Laparoscopic Surgery on Fertility Outcomes in Patients with Minimal/Mild Endometriosis
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Fujii, M., Koshiba, A., Ito, F., Kusuki, I., Kitawaki, J., & Mori, T. (2023) · Gynecology and Minimally Invasive Therapy · doi:10.4103/gmit.gmit_132_22 · Cited by 3 · see citing works
- Authors
- Vercellini, P., Somigliana, E., Vigano, P., Abbiati, A., Barbara, G., & Crosignani, P. G.
- Affiliations
- University of Milan (IT)
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico (IT)
- Venue
- Human Reproduction
- Publisher
- Oxford University Press (OUP)
- Published
- 2009-02-01
- Volume
- 24
- Issue
- 2
- Pages
- 254-269
- ISSN
- 0268-1161 (ISSN-L)
- 1460-2350
- OpenAlex
- W2129744763
- Cited by
- 269
- References
- 142
- Citations by year
- 2026: 11 · 2025: 9 · 2024: 11 · 2023: 16 · 2022: 15 · 2021: 18 · 2020: 14 · 2019: 9 · 2018: 11 · 2017: 11 · 2016: 17 · 2015: 24 · 2014: 13 · 2013: 20 · 2012: 18
- FWCI
- 19.52
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Human Reproduction (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Reproductive Medicine › Endometriosis Research and Treatment
- Health Sciences › Medicine › Obstetrics and Gynecology › Gynecological conditions and treatments
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ectopic Pregnancy Diagnosis and Management
- Keywords
- endometriosis-associated infertility, laparoscopic surgery, conservative surgery, endometrioma, rectovaginal endometriosis, peritoneal endometriosis, in vitro fertilization, surgical risks and benefits, evidence synthesis
- MeSH terms
- Endometriosis, Female, Fertilization in Vitro, Humans, Infertility, Female, Laparoscopy, Pregnancy, Recurrence, Risk Factors, Gynecologic Surgical Procedures, Randomized Controlled Trials as Topic, Chemotherapy, Adjuvant, Practice Guidelines as Topic, Pregnancy Rate
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