Background Minimal or mild endometriosis is frequently diagnosedin infertile women. It is often treated by resection or ablationof the lesions, but whether this improves fertility has notbeen established. We carried out a randomized, controlled trialto determine whether laparoscopic surgery enhanced fecundityin infertile women with minimal or mild endometriosis.
Methods We studied 341 infertile women 20 to 39 years of agewith minimal or mild endometriosis. During diagnostic laparoscopythe women were randomly assigned to undergo resection or ablationof visible endometriosis or diagnostic laparoscopy only. Theywere followed for 36 weeks after the laparoscopy or, for thosewho became pregnant during that interval, for up to 20 weeksof pregnancy.
Results Among the 172 women who had resection or ablation ofendometriosis, 50 became pregnant and had pregnancies that continuedfor 20 weeks or longer, as compared with 29 of the 169 womenin the diagnostic-laparoscopy group (cumulative probabilities,30.7 percent and 17.7 percent, respectively; P = 0.006 by thelog-rank test). The corresponding rates of fecundity were 4.7and 2.4 per 100 person-months (rate ratio, 1.9; 95 percent confidenceinterval, 1.2 to 3.1). Fetal losses occurred in 20.6 percentof all the recognized pregnancies in the laparoscopic-surgerygroup and in 21.6 percent of all those in the diagnostic-laparoscopygroup (P = 0.91). Four minor operative complications (intestinalcontusion, slight tear of the tubal serosa, difficult pneumoperitoneum,and vascular trauma) were reported (three in the surgery groupand one in the control group).
Conclusions Laparoscopic resection or ablation of minimal andmild 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.
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]
Palomba, S., Orio, F. Jr., Falbo, A., Russo, T., Tolino, A., Zullo, F.
(2007). Clomiphene Citrate Versus Metformin as First-Line Approach for the Treatment of Anovulation in Infertile Patients with Polycystic Ovary Syndrome. J. Clin. Endocrinol. Metab.
92: 3498-3503
[Abstract][Full Text]
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]
Winkel, C. A.
(2003). Evaluation and Management of Women With Endometriosis. Obstet Gynecol
102: 397-408
[Abstract][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]
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]
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]
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]
