Dear Dr William Gibbons
We highly appreciate your kind editorial on our article concerning reproductive outcome in women with RVE treated either conservatively or operatively. We do believe that we can choose the treatment of RVE based on the symptoms; women suffering from severe pain should be operated but women having tolerable pain together with a wish for pregnancy could be first offered medically assisted reproduction without surgery. Every woman is entitled to the best possible treatment and that is why centers of excellence are recommended by WES, ESHRE and ESGE for both infertility treatment as well as for endometriosis surgery. In addition, continuous collaboration with infertility and operative colleagues helps to optimize the treatment for each woman. Operative treatment should be carried out according to the international guidelines with multidisciplinary teams to avoid repeat and incomplete surgeries (1-2). Surgical experience seems to be important for the good outcome (3).
Women living with RVE have good reproductive prognosis but high number of pregnancy and delivery complications. Most of the deliveries end up in Cesarean section. Women should be informed of these risks and thorough follow-up of these pregnancies is recommended.
Päivi Härkki MD PhD
Department of Obstetrics and Gynecology
Helsinki University Hospital, Helsinki, Finland
- Dunselman GAJ, Vermeulen N, Becker C et al. ESHRE guidelines: management of women with endometriosis. Hum Reprod 2014;29(3):400-12.
- Working group of ESGE, ESHRE and WES. Keckstein J, Becker CM, Canis M et al. Recommendations for the surgical treatment of endometriosis. Part 2: deep endometriosis. Hum Reprod Open. 2020 Feb 12;2020(1):hoaa002.
- Byrne D, Curnow T, Smith P et al. Laparoscopic excision of deep rectovaginal endometriosis in BSGE endometriosis centres: a multicentre prospective cohort study. BMJ Open2018 Apr 9;8(4):e018924.