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Evidence summaries

Laparoscopic Surgery for Subfertility Associated with Endometriosis

The use of laparoscopic surgery in the treatment of endometriosis appears to improve pregnancy success rates. Level of evidence: "B"

A Cochrane review cd011031 (abstract , review [Abstract]) included 3 studies with a total of 535 subjects. Compared with diagnostic laparoscopy, laparoscopic surgery was associated with an increased viable intrauterine pregnancy confirmed by ultrasound (OR 1.89, 95% CI 1.25 to 2.86; 3 RCTs, n=528).

A retrospective cohort study 2 included all women (n=78) who failed IVF treatment before surgery and who underwent laparoscopic surgery for severe endometriosis between January 2006 and December 2014. After surgical treatment 33 women (42.3%) delivered. Three women (9%) conceived spontaneously and all other women conceived after IVF treatment. In addition, performing salpingectomy during surgery was associated with a trend of improvement in delivery rates after surgery (70% in women who delivered vs. 51% in women who failed to deliver).

Comment: The quality of evidence is downgraded by imprecise results (few outcome events).

    References

    • Bafort C, Beebeejaun Y, Tomassetti C et al. Laparoscopic surgery for endometriosis. Cochrane Database Syst Rev 2020;(10):CD011031. [PubMed]
    • Soriano D, Adler I, Bouaziz J et al. Fertility outcome of laparoscopic treatment in patients with severe endometriosis and repeated in vitro fertilization failures. Fertil Steril 2016;106(5):1264-1269. [PubMed]

Primary/Secondary Keywords