Surgery for Endometriosis Can Improve Fertility

NEW YORK (Reuters Health) - Women with endometriosis that involves the bowel find their chances of becoming pregnant go up substantially after they undergo "keyhole" surgery to remove the affected section of bowel, a new report indicates.

Endometriosis occurs when tissue that normally lines the womb also grows at other sites within the abdomen, which may include the surface of the digestive tract. This can cause severe pain and infertility problems.

Previous reports have shown standard surgery markedly enhances fertility in women with so-called colorectal endometriosis, and recently it has been shown that performing the procedure under laparoscopy is feasible. However, little was known about the effect of this minimally invasive approach on fertility.

To investigate, Dr. Emile Darai, from Hopital Tenon in Paris, and colleagues assessed the fertility outcomes of 22 endometriosis patients who underwent laparoscopic colorectal resection and wanted to conceive. The average follow-up period after surgery was 24 months.

Ten of the women (45 percent) became pregnant after an average of 8 months, the researchers report in the medical journal Fertility and Sterility.

A total of 12 pregnancies occurred -- nine through spontaneous conception and three after in vitro fertilization.

The nine spontaneous pregnancies included seven delivered vaginally, one delivered by c-section, and one ongoing pregnancy. The IVF pregnancies included one miscarriage, one ongoing twin pregnancy, and one triplet pregnancy that resulted in two surviving infants.

Therefore, the live birth rate was 82 percent.

These preliminary results after laparoscopic removal of a segment of the colon for endometriosis "tend to confirm that extensive surgery can enhance fertility," the team writes. Further trials are required to identify "the patient population most likely to benefit from this major surgery."

SOURCE: Fertility and Sterility, October 2005.