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. The journal publishes juried original scientific articles in clinical and laboratory research relevant to reproductive endocrinology, urology, andrology, physiology, immunology, genetics, contraception, and menopause. Fertility and Sterility® encourages and supports meaningful basic and clinical research, and facilitates and promotes excellence in professional education, in the field of reproductive medicine.

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