Colorectal endometriosis-associated infertility: should surgery precede ART?

Comparing the impact of first-line assisted reproductive technology (ART) intracytoplasmic sperm injection– in vitro fertilization and first-line colorectal surgery followed by ART on fertility outcomes in women with colorectal endometriosis-associated infertility shows that surgery may be a good option.

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Volume 108, Issue 3, Pages 525–531.e4

Authors:

Sofiane Bendifallah, M.D., Ph.D., Horace Roman, M.D., Ph.D., Emmanuelle Mathieu d'Argent, M.D., Salma Touleimat, M.D., Jonathan Cohen, M.D., Ph.D., Emile Darai, M.D., Ph.D., Marcos Ballester, M.D., Ph.D.

Abstract:

Objective

To compare the impact of first-line assisted reproductive technology (ART; intracytoplasmic sperm injection [ICSI]-IVF) and first-line colorectal surgery followed by ART on fertility outcomes in women with colorectal endometriosis-associated infertility.

Design

Retrospective matched cohort study using propensity score (PS) matching (PSM) analysis.

Setting

University referral centers.

Patient(s)

A total of 110 women were analyzed from January 2005 to June 2014. A PSM was generated using a logistic regression model based on the age, antimüllerian hormone (AMH) serum level, and presence of adenomyosis to compare the treatment strategy.

Intervention(s)

First-line surgery group followed by ART versus exclusive ART with in situ colorectal endometriosis.

Main Outcome Measure(s)

After PSM, pregnancy rates (PRs), live-birth rates (LBRs), and cumulative rates (CRs) were estimated.

Result(s)

After PSM, in the whole population, the total LBR and PR were 35.4% (39/110) and 49% (54/110), respectively. The specific cumulative LBR at the first ICSI-IVF cycle in the first-line surgery group compared with the first-line ART was, respectively, 32.7% versus 13.0%; at the second cycle, 58.9% versus 24.8%; and at the third cycle, 70.6% versus 54.9%. The cumulative LBRs were significantly higher for women who underwent first-line surgery followed by ART compared with first-line ART in the subset of women with good prognosis (age ≤ 35 years and AMH ≥ 2 ng/mL and no adenomyosis) and women with AMH serum level < 2 ng/mL.

Conclusion(s)

First-line surgery may be a good option for women with colorectal endometriosis-associated infertility.


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Fertility and Sterility

Editorial Office, American Society for Reproductive Medicine

Fertility and Sterility® is an international journal for obstetricians, gynecologists, reproductive endocrinologists, urologists, basic scientists and others who treat and investigate problems of infertility and human reproductive disorders.