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Volume 337:217-222 July 24, 1997 Number 4 Next

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ABSTRACT

Background Minimal or mild endometriosis is frequently diagnosed in infertile women. It is often treated by resection or ablation of the lesions, but whether this improves fertility has not been established. We carried out a randomized, controlled trial to determine whether laparoscopic surgery enhanced fecundity in infertile women with minimal or mild endometriosis.

Methods We studied 341 infertile women 20 to 39 years of age with minimal or mild endometriosis. During diagnostic laparoscopy the women were randomly assigned to undergo resection or ablation of visible endometriosis or diagnostic laparoscopy only. They were followed for 36 weeks after the laparoscopy or, for those who became pregnant during that interval, for up to 20 weeks of pregnancy.

Results Among the 172 women who had resection or ablation of endometriosis, 50 became pregnant and had pregnancies that continued for 20 weeks or longer, as compared with 29 of the 169 women in the diagnostic-laparoscopy group (cumulative probabilities, 30.7 percent and 17.7 percent, respectively; P = 0.006 by the log-rank test). The corresponding rates of fecundity were 4.7 and 2.4 per 100 person-months (rate ratio, 1.9; 95 percent confidence interval, 1.2 to 3.1). Fetal losses occurred in 20.6 percent of all the recognized pregnancies in the laparoscopic-surgery group and in 21.6 percent of all those in the diagnostic-laparoscopy group (P = 0.91). Four minor operative complications (intestinal contusion, slight tear of the tubal serosa, difficult pneumoperitoneum, and vascular trauma) were reported (three in the surgery group and one in the control group).

Conclusions Laparoscopic resection or ablation of minimal and mild endometriosis enhances fecundity in infertile women.

Source Information

From the Centre Hospitalier Universitaire de Québec, Pavillon Saint-François d'Assise (S.M., R.M., S.B.), and Laval University Epidemiology Research Group (S.M., S.B.), Quebec, Canada.

Address reprint requests to Dr. Maheux at the Centre Hospitalier Universitaire de Québec, Pavillon Saint-François d'Assise, 10 rue de l'Espinay, Québec, QC G1L 3L5, Canada.

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• Creus, M., Fabregues, F., Carmona, F., del Pino, M., Manau, D., Balasch, J. (2008). Combined laparoscopic surgery and pentoxifylline therapy for treatment of endometriosis-associated infertility: a preliminary trial. Hum Reprod 23: 1910-1916 [Abstract] [Full Text]  
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• Bosteels, J., Van Herendael, B., Weyers, S., D'Hooghe, T. (2007). The position of diagnostic laparoscopy in current fertility practice. Hum Reprod Update 13: 477-485 [Abstract] [Full Text]  
• Siristatidis, C., Bhattacharya, S. (2007). Unexplained infertility: does it really exist? Does it matter?. Hum Reprod 22: 2084-2087 [Abstract] [Full Text]  
• Simoens, S., Hummelshoj, L., D'Hooghe, T. (2007). Endometriosis: cost estimates and methodological perspective. Hum Reprod Update 13: 395-404 [Abstract] [Full Text]  
• Martinez, S., Garrido, N., Coperias, J.L., Pardo, F., Desco, J., Garcia-Velasco, J.A., Simon, C., Pellicer, A. (2007). Serum interleukin-6 levels are elevated in women with minimal-mild endometriosis. Hum Reprod 22: 836-842 [Abstract] [Full Text]  
• Nishida, M., Nasu, K., Ueda, T., Yuge, A., Takai, N., Narahara, H. (2006). beta-Hydroxyisovalerylshikonin induces apoptosis and G0/G1 cell-cycle arrest of endometriotic stromal cells: a preliminary in vitro study. Hum Reprod 21: 2850-2856 [Abstract] [Full Text]  
• Nawroth, F., Rahimi, G., Nawroth, C., Foth, D., Ludwig, M., Schmidt, T. (2006). Is there an association between septate uterus and endometriosis?. Hum Reprod 21: 542-544 [Abstract] [Full Text]  
• Nasu, K., Nishida, M., Ueda, T., Takai, N., Bing, S., Narahara, H., Miyakawa, I. (2005). Bufalin induces apoptosis and the G0/G1 cell cycle arrest of endometriotic stromal cells: a promising agent for the treatment of endometriosis. Mol Hum Reprod 11: 817-823 [Abstract] [Full Text]  
• Tanahatoe, S.J., Lambalk, C.B., Hompes, P.G.A. (2005). The role of laparoscopy in intrauterine insemination: a prospective randomized reallocation study. Hum Reprod 20: 3225-3230 [Abstract] [Full Text]  
• Kennedy, S., Bergqvist, A., Chapron, C., D'Hooghe, T., Dunselman, G., Greb, R., Hummelshoj, L., Prentice, A., Saridogan, E., on behalf of the ESHRE Special Interest Group for, (2005). ESHRE guideline for the diagnosis and treatment of endometriosis. Hum Reprod 20: 2698-2704 [Abstract] [Full Text]  
• Kunz, G., Beil, D., Huppert, P., Noe, M., Kissler, S., Leyendecker, G. (2005). Adenomyosis in endometriosis--prevalence and impact on fertility. Evidence from magnetic resonance imaging. Hum Reprod 20: 2309-2316 [Abstract] [Full Text]  
• Omland, A. K., Abyholm, T., Fedorcsak, P., Ertzeid, G., Oldereid, N. B., Bjercke, S., Tanbo, T. (2005). Pregnancy outcome after IVF and ICSI in unexplained, endometriosis-associated and tubal factor infertility. Hum Reprod 20: 722-727 [Abstract] [Full Text]  
• de Kroon, C.D., van der Sandt, H.A.G.M., van Houwelingen, J.C., Jansen, F.W. (2004). Sonographic assessment of non-malignant ovarian cysts: does sonohistology exist?. Hum Reprod 19: 2138-2143 [Abstract] [Full Text]  
• Calhaz-Jorge, C., Mol, B. W., Nunes, J., Costa, A.P. (2004). Clinical predictive factors for endometriosis in a Portuguese infertile population. Hum Reprod 19: 2126-2131 [Abstract] [Full Text]  
• Brosens, I., Gordts, S., Valkenburg, M., Puttemans, P., Campo, R., Gordts, S. (2004). Investigation of the infertile couple: when is the appropriate time to explore female infertility?. Hum Reprod 19: 1689-1692 [Abstract] [Full Text]  
• ESHRE Capri Workshop Group, (2004). Diagnosis and management of the infertile couple: missing information. Hum Reprod Update 10: 295-307 [Abstract] [Full Text]  
• Collins, J. A., Van Steirteghem, A. (2004). Overall prognosis with current treatment of infertility. Hum Reprod Update 10: 309-316 [Abstract] [Full Text]  
• Garry, R. (2004). The endometriosis syndromes: a clinical classification in the presence of aetiological confusion and therapeutic anarchy. Hum Reprod 19: 760-768 [Abstract] [Full Text]  
• Akande, V. A., Hunt, L. P., Cahill, D. J., Jenkins, J. M. (2004). Differences in time to natural conception between women with unexplained infertility and infertile women with minor endometriosis. Hum Reprod 19: 96-103 [Abstract] [Full Text]  
• Smith, S., Pfeifer, S. M., Collins, J. A. (2003). Diagnosis and Management of Female Infertility. JAMA 290: 1767-1770 [Full Text]  
• Hart, R. (2003). Unexplained infertility, endometriosis, and fibroids. BMJ 327: 721-724 [Full Text]  
• Kavallaris, A., Kohler, C., Kuhne-Heid, R., Schneider, A. (2003). Histopathological extent of rectal invasion by rectovaginal endometriosis. Hum Reprod 18: 1323-1327 [Abstract] [Full Text]  
• Check, J. H. (2003). What role does decreased ovarian reserve play in the aetiology of infertility related to endometriosis?. Hum Reprod 18: 653-654 [Full Text]  
• Cahill, D.J. (2003). What role does decreased ovarian reserve play in the aetiology of infertility related to endometriosis? Reply. Hum Reprod 18: 654-655 [Full Text]  
• Tanahatoe, S. J., Hompes, P. G.A., Lambalk, C. B. (2003). Investigation of the infertile couple: Should diagnostic laparoscopy be performed in the infertility work up programme in patients undergoing intrauterine insemination?. Hum Reprod 18: 8-11 [Abstract] [Full Text]  
• Papaioannou, S., Afnan, M., Olufowobi, O., Sharif, K. (2002). Investigation of the infertile couple: laparoscopy after normal hysterosalpingography?. Hum Reprod 17: 1928-1929 [Full Text]  
• Fatum, M. (2002). Investigation of the infertile couple: laparoscopy after normal hysterosalpingography?. Hum Reprod 17: 1929-1929 [Full Text]  
• Cahill, D.J. (2002). What is the optimal medical management of infertility and minor endometriosis?: Analysis and future prospects. Hum Reprod 17: 1135-1140 [Abstract] [Full Text]  
• Vigano, P., Somigliana, E., Matrone, R., Dubini, A., Barron, C., Vignali, M., di Blasio, A. M. (2002). Serum Leptin Concentrations in Endometriosis. J. Clin. Endocrinol. Metab. 87: 1085-1087 [Abstract] [Full Text]  
• Akoum, A., Lawson, C., McColl, S., Villeneuve, M. (2001). Ectopic endometrial cells express high concentrations of interleukin (IL)-8 in vivo regardless of the menstrual cycle phase and respond to oestradiol by up-regulating IL-1-induced IL-8 expression in vitro. Mol Hum Reprod 7: 859-866 [Abstract] [Full Text]  
• Olive, D. L., Pritts, E. A. (2001). Treatment of Endometriosis. NEJM 345: 266-275 [Full Text]  
• Prentice, A. (2001). Regular review: Endometriosis. BMJ 323: 93-95 [Full Text]  
• Balasch, J. (2000). Investigation of the infertile couple: Investigation of the infertile couple in the era of assisted reproductive technology: a time for reappraisal. Hum Reprod 15: 2251-2257 [Abstract] [Full Text]  
• Al-Inany, H.G., Crosignani, P.G., Vercellini, P. (2000). Evidence may change with more trials: concepts to be kept in mind. Hum Reprod 15: 2447-2448 [Full Text]  
• Farquhar, C. M (2000). Extracts from "Clinical Evidence": Endometriosis. BMJ 320: 1449-1452 [Abstract] [Full Text]  
• (2000). Optimal use of infertility diagnostic tests and treatments. Hum Reprod 15: 723-732 [Abstract] [Full Text]  
• Akoum, A., Jolicoeur, C., Boucher, A. (2000). Estradiol Amplifies Interleukin-1-Induced Monocyte Chemotactic Protein-1 Expression by Ectopic Endometrial Cells of Women with Endometriosis. J. Clin. Endocrinol. Metab. 85: 896-904 [Abstract] [Full Text]  
• Adamson, G. D. (1999). A 36-Year-Old Woman With Endometriosis, Pelvic Pain, and Infertility. JAMA 282: 2347-2354 [Full Text]  
• Yusoff Dawood, M. (1999). Laparoscopic Surgery of the Fallopian Tubes and Ovaries. SURG INNOV 6: 58-67 [Abstract]  
• Mol, B. W.J., Collins, J. A., Burrows, E. A., van der Veen, F., Bossuyt, P. M.M. (1999). Comparison of hysterosalpingography and laparoscopy in predicting fertility outcome. Hum Reprod 14: 1237-1242 [Abstract] [Full Text]  
• dell'Endometriosi, G. I. p. l. S. (1999). Ablation of lesions or no treatment in minimal–mild endometriosis in infertile women: a randomized trial. Hum Reprod 14: 1332-1334 [Abstract] [Full Text]  
• (1999). Managing endometriosis. DTB 37: 25-29 [Abstract] [Full Text]  
• Akoum, A., Lavoie, J., Drouin, R., Jolicoeur, C., Lemay, A., Maheux, R., Khandjian, E. W. (1999). Physiological and Cytogenetic Characterization of Immortalized Human Endometriotic Cells Containing Episomal Simian Virus 40 DNA. Am. J. Pathol. 154: 1245-1257 [Abstract] [Full Text]  
• Zeitoun, K., Takayama, K., Michael, M. D., Bulun, S. E. (1999). Stimulation of Aromatase P450 Promoter (II) Activity in Endometriosis and Its Inhibition in Endometrium Are Regulated by Competitive Binding of Steroidogenic Factor-1 and Chicken Ovalbumin Upstream Promoter Transcription Factor to the Same cis-Acting Element. Mol. Endocrinol. 13: 239-253 [Abstract] [Full Text]  
• Chapron, C., Fritel, X., Dubuisson, J.-B. (1999). Fertility after laparoscopic management of deep endometriosis infiltrating the uterosacral ligaments. Hum Reprod 14: 329-332 [Abstract] [Full Text]  
• Zeitoun, K., Takayama, K., Sasano, H., Suzuki, T., Moghrabi, N., Andersson, S., Johns, A., Meng, L., Putman, M., Carr, B., Bulun, S. E. (1998). Deficient 17{beta}-Hydroxysteroid Dehydrogenase Type 2 Expression in Endometriosis: Failure to Metabolize 17{beta}-Estradiol. J. Clin. Endocrinol. Metab. 83: 4474-4480 [Abstract] [Full Text]  
• (1997). Laparoscopic Surgery for Infertile Women with Endometriosis. JWatch Women's Health 1997: 11-11 [Full Text]  
• (1997). LAPAROSCOPIC SURGERY FOR INFERTILE WOMEN WITH MILD ENDOMETRIOSIS. JWatch General 1997: 1-1 [Full Text]  
• Gambone, J. C., DeCherney, A. H. (1997). Surgical Treatment of Minimal Endometriosis. NEJM 337: 269-270 [Full Text]