Does surgery for deep infiltrating bowel endometriosis improve fertility? A systematic review
Open accessAbstract
Introduction: Reduced fertility is a major concern in women with endometriosis. The influence of surgery of deep infiltrating endometriosis ( DIE ) affecting the bowel wall on fertility is controversial and the literature on this field is heterogeneous. In this review we addressed whether surgery for bowel DIE improves the spontaneous pregnancy rate, and the results of in vitro fertilization ( IVF ), and the potential risk of such surgery. Material and methods: We conducted a literature search including the terms “deep”, “deep infiltrating”, “bowel”, rectovaginal”, “endometriosis”, “fertility”, “infertility” and “ IVF ” in PubMed. Results: No randomized controlled studies were found. Other publications of relevance included four retrospective and three prospective observational studies. Moreover, one retrospective study compared results of IVF treatment with or without previous surgery for bowel DIE . All studies reported detailed data on surgical complications. The poor data quality precluded firm conclusions. The results indicate, however, the possibility that surgery for bowel DIE may improve the spontaneous pregnancy rate, and positive effects on IVF outcome cannot be excluded. Such surgery will be associated with risk of major complications. Conclusion: The lack of proper data precludes conclusions on the potential role for bowel DIE surgery to improve the spontaneous pregnancy rate and results of IVF treatment. Positive effects cannot be excluded, but the definite risk of major complications must be taken into account.
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No compelling evidence exists that operative laparoscopy for deep endometriosis improves fertility.
“Although no compelling evidence exists that operative laparoscopy for deep endometriosis improves fertility, operative laparoscopy may represent a treatment option in symptomatic patients wishing to conceive (Meuleman et al., 2011; Vercellini et al., 2012; Iversen et al., 2017).”
From ESHRE guideline: endometriosis (2022) · cites this paper as Iversen et al., 2017
The Key message and Abstract (page not specified in our copy) say evidence for a fertility benefit from surgery is sparse and poor quality, with no randomized controlled studies and no firm conclusion. That supports the claim’s assessment of the evidence, but the review concerns deep infiltrating endometriosis affecting the bowel wall, not operative laparoscopy for deep endometriosis generally. (LLM, conf=0.84)
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Cites
ESHRE guideline: management of women with endometriosis
Dunselman, G. A. J., Vermeulen, N., Becker, C., Calhaz-Jorge, C., D'Hooghe, T., De Bie, B., Heikinheimo, O., Horne, A. W., Kiesel, L., Nap, A., et al. (2014) · Human Reproduction · doi:10.1093/humrep/det457 · Cited by 2,211 · see citing works
GRADE guidelines: 2. Framing the question and deciding on important outcomes
Guyatt, G. H., Oxman, A. D., Kunz, R., Atkins, D., Brozek, J., Vist, G., Alderson, P., Glasziou, P., Falck-Ytter, Y., & Schünemann, H. J. (2011) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2010.09.012 · Cited by 1,911 · see citing works
Rahbari, N. N., Weitz, J., Hohenberger, W., Heald, R. J., Moran, B. J., Ulrich, A. B., Holm, T., Wong, W. D., Tiret, E., Moriya, Y., et al. (2009) · Surgery · doi:10.1016/j.surg.2009.10.012 · Cited by 1,572 · see citing works
Laparoscopic Surgery in Infertile Women with Minimal or Mild Endometriosis
Marcoux, S., Maheux, R., & Bérubé, S. (1997) · New England Journal of Medicine · doi:10.1056/nejm199707243370401 · Cited by 948 · see citing works
Endometriosis and infertility: pathophysiology and management
de Ziegler, D., Borghese, B., & Chapron, C. (2010) · The Lancet · doi:10.1016/s0140-6736(10)60490-4 · Cited by 836 · see citing works
Effect of endometriosis on in vitro fertilization
Barnhart, K. T., Dunsmoor-Su, R. F., & Coutifaris, C. (2002) · Fertility and Sterility · doi:10.1016/s0015-0282(02)03112-6 · Cited by 798 · see citing works
<i>Endometriosis and Infertility</i>: <i>Epidemiology and Evidence‐based Treatments</i>
Ozkan, S., Murk, W., & Arici, A. (2008) · Annals of the New York Academy of Sciences · doi:10.1196/annals.1434.007 · Cited by 347 · see citing works
Surrey, E. S., Silverberg, K. M., Surrey, M., & Schoolcraft, W. B. (2002) · Fertility and Sterility · doi:10.1016/s0015-0282(02)03373-3 · Cited by 225 · see citing works
Minelli, L. (2009) · Archives of Surgery · doi:10.1001/archsurg.2008.555 · Cited by 170 · see citing works
Laparoscopic treatment of bowel endometriosis in infertile women
Stepniewska, A., Pomini, P., Bruni, F., Mereu, L., Ruffo, G., Ceccaroni, M., Scioscia, M., Guerriero, M., & Minelli, L. (2009) · Human Reproduction · doi:10.1093/humrep/dep083 · Cited by 146 · see citing works
Laparoscopic segmental colorectal resection for endometriosis: limits and complications
Daraï, É., Ackerman, G., Bazot, M., Rouzier, R., & Dubernard, G. (2007) · Surgical Endoscopy · doi:10.1007/s00464-006-9160-1 · Cited by 143 · see citing works
Fertility after laparoscopic colorectal resection for endometriosis: preliminary results
Daraï, É., Marpeau, O., Thomassin‐Naggara, I., Dubernard, G., Barranger, E., & Bazot, M. (2005) · Fertility and Sterility · doi:10.1016/j.fertnstert.2005.04.037 · Cited by 115 · see citing works
Malzoni, M., Di Giovanni, A., Exacoustos, C., Lannino, G., Capece, R., Perone, C., Rasile, M., & Iuzzolino, D. (2016) · Journal of Minimally Invasive Gynecology · doi:10.1016/j.jmig.2015.09.024 · Cited by 87 · see citing works
Meuleman, C., D’Hoore, A., Cleynenbreugel, B. V., Beks, N., & D’Hooghe, T. M. (2009) · Reproductive BioMedicine Online · doi:10.1016/s1472-6483(10)60267-2 · Cited by 86 · see citing works
Prentice, A. (2001) · BMJ · doi:10.1136/bmj.323.7304.93 · Cited by 77 · see citing works
Riiskjær, M., Greisen, S., Glavind‐Kristensen, M., Kesmodel, U., Forman, A., & Seyer‐Hansen, M. (2016) · BJOG: An International Journal of Obstetrics & Gynaecology · doi:10.1111/1471-0528.13975 · Cited by 74 · see citing works
Self-citationFull-Thickness Disc Excision in Deep Endometriotic Nodules of the Rectum
Roman, H., Abo, C., Huet, E., Bridoux, V., Auber, M., Oden, S., Marpeau, L., & Tuech, J. (2015) · Diseases of the Colon & Rectum · doi:10.1097/dcr.0000000000000447 · Cited by 65 · see citing works
Determinant factors of fertility outcomes after laparoscopic colorectal resection for endometriosis
Daraï, É., Carbonnel, M., Dubernard, G., Lavoué, V., Coutant, C., Bazot, M., & Ballester, M. (2010) · European Journal of Obstetrics & Gynecology and Reproductive Biology · doi:10.1016/j.ejogrb.2009.12.032 · Cited by 60 · see citing works
Ballester, M., Roman, H., d’Argent, E. M., Touleimat, S., Belghiti, J., & Daraï, É. (2016) · European Journal of Obstetrics & Gynecology and Reproductive Biology · doi:10.1016/j.ejogrb.2016.02.020 · Cited by 48 · see citing works
Ballester, M., Oppenheimer, A., Mathieu d’Argent, E., Touboul, C., Antoine, J.-M., Nisolle, M., & Daraï, E. (2012) · Fertility and Sterility · doi:10.1016/j.fertnstert.2011.11.022 · Cited by 44 · see citing works
Roman, H., Puscasiu, L., Lempicki, M., Huet, E., Chati, R., Bridoux, V., Tuech, J.-J., & Abo, C. (2015) · Journal of Minimally Invasive Gynecology · doi:10.1016/j.jmig.2015.05.023 · Cited by 41 · see citing works
Gordon, S. J., Maher, P. J., & Woods, R. (2001) · The Journal of the American Association of Gynecologic Laparoscopists · doi:10.1016/s1074-3804(05)60598-1 · Cited by 38 · see citing works
Laparoscopic Rectal Resection of Deep Infiltrating Endometriosis
Jelenc, F., Ribič-Pucelj, M., Juvan, R., Kobal, B., Šinkovec, J., & Šalamun, V. (2011) · Journal of Laparoendoscopic & Advanced Surgical Techniques · doi:10.1089/lap.2011.0307 · Cited by 37 · see citing works
Colorectal endometriosis and pregnancy wish why doing primary surgery
Roman, H. (2015) · Frontiers in Bioscience · doi:10.2741/s426 · Cited by 37 · see citing works
Kavallaris, A., CHALVATZAS, N., Hornemann, A., Banz, C., Diedrich, K., & Agic, A. (2010) · Archives of Gynecology and Obstetrics · doi:10.1007/s00404-010-1499-9 · Cited by 34 · see citing works
Roman, H., & Tuech, J. (2014) · Colorectal Disease · doi:10.1111/codi.12605 · Cited by 22 · see citing works
Conservative approach to rectosigmoid endometriosis: a cohort study
Egekvist, A. G., Marinovskij, E., Forman, A., Kesmodel, U. S., Riiskjær, M., & Seyer‐Hansen, M. (2017) · Acta Obstetricia et Gynecologica Scandinavica · doi:10.1111/aogs.13094 · Cited by 15 · see citing works
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ESHRE guideline: endometriosis
Becker, C. M., Bokor, A., Heikinheimo, O., Horne, A., Jansen, F., Kiesel, L., King, K., Kvaskoff, M., Nap, A., Petersen, K., et al. (2022) · Human Reproduction Open · doi:10.1093/hropen/hoac009 · Cited by 1,712 · see citing works
“Although no compelling evidence exists that operative laparoscopy for deep endometriosis improves fertility, operative laparoscopy may represent a treatment option in symptomatic patients wishing to conceive (Meuleman et al. , 2011; Vercellini et al. , 2012; Iversen et al. , 2017).”
Hudelist, G., Aas‐Eng, M. K., Birsan, T., Berger, F., Sevelda, U., Kirchner, L., Salama, M., & Dauser, B. (2018) · Acta Obstetricia et Gynecologica Scandinavica · doi:10.1111/aogs.13436 · Cited by 75 · see citing works
Bokor, A., Hudelist, G., Dobó, N., Dauser, B., Farella, M., Brubel, R., Tuech, J., & Roman, H. (2021) · Acta Obstetricia et Gynecologica Scandinavica · doi:10.1111/aogs.14046 · Cited by 42 · see citing works
Vercellini, P., Buggio, L., Borghi, A., Monti, E., Gattei, U., & Frattaruolo, M. P. (2018) · Acta Obstetricia et Gynecologica Scandinavica · doi:10.1111/aogs.13328 · Cited by 39 · see citing works
Management of endometriosis: Toward value-based, cost-effective, affordable care
Vercellini, P., Facchin, F., Buggio, L., Barbara, G., Berlanda, N., Frattaruolo, M. P., & Somigliana, E. (2018) · Journal of Obstetrics and Gynaecology Canada · doi:10.1016/j.jogc.2017.07.011 · Cited by 36 · see citing works
Hudelist, G., Korell, M., Burkhardt, M., Chvatal, R., Darici, E., Dimitrova, D., Drahonovsky, J., Haj Hamoud, B., Hornung, D., Krämer, B., et al. (2022) · Acta Obstetricia et Gynecologica Scandinavica · doi:10.1111/aogs.14418 · Cited by 28 · see citing works
Darici, E., Salama, M., Bokor, A., Oral, E., Dauser, B., & Hudelist, G. (2022) · Acta Obstetricia et Gynecologica Scandinavica · doi:10.1111/aogs.14379 · Cited by 18 · see citing works
Long‐term surgical outcomes of nerve‐sparing discoid and segmental resection for deep endometriosis
Darici, E., Denkmayr, D., Pashkunova, D., Dauser, B., Birsan, T., & Hudelist, G. (2022) · Acta Obstetricia et Gynecologica Scandinavica · doi:10.1111/aogs.14411 · Cited by 14 · see citing works
- Authors
- Iversen, M. L., Seyer‐Hansen, M., & Forman, A.
- Affiliations
- Aarhus University Hospital (DK)
- Corresponding author
- Iversen, Maja L.
- Venue
- Acta Obstetricia et Gynecologica Scandinavica
- Publisher
- Wiley
- Published
- 2017-05-28
- Volume
- 96
- Issue
- 6
- Pages
- 688-693
- ISSN
- 0001-6349 (ISSN-L)
- 1600-0412
- OpenAlex
- W2607271160
- Cited by
- 76
- References
- 27
- Citations by year
- 2026: 6 · 2025: 4 · 2024: 10 · 2023: 5 · 2022: 13 · 2021: 6 · 2020: 16 · 2018: 11 · 2017: 5
- FWCI
- 1.44
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Acta Obstetricia Et Gynecologica Scandinavica (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
- deep infiltrating endometriosis, bowel endometriosis, endometriosis surgery, fertility, infertility, spontaneous pregnancy rate, IVF outcomes, surgical complications, rectovaginal endometriosis
- MeSH terms
- Endometriosis, Female, Fertilization in Vitro, Humans, Infertility, Female, Intestinal Diseases, Pregnancy, Pregnancy Rate
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