Women who have had surgery for deep infiltrating endometriosis and want to get pregnant have a reasonably high chance of conception, even after multiple failed in vitro fertilization (IVF) attempts, a new study suggests.
The study, “Pregnancy rates after surgical treatment of deep infiltrating endometriosis in infertile patients with at least 2 previous IVF / ICSI failures,” was published in the Journal of Minimally Invasive Gynecology.
Endometriosis can cause infertility, and there has been debate about how to manage this for people who want to get pregnant – specifically, whether it is better to try assisted reproductive techniques (eg IVF) before or after surgery.
In the new study, researchers looked at clinical data from the CIRENDO database, which records such data for people with endometriosis who are managed at one of several clinics in France.
The researchers specifically looked at patients younger than 43 who had undergone at least two previous IVF attempts, had endometriosis surgery, and stated a desire to become pregnant after surgery.
The researchers identified records for 73 patients matching these criteria and with at least one year’s worth of post-surgical data. Most of these patients had stage IV endometriosis; the average number of previous IVF attempts was 3.7.
At the time the data was available, 32 (43.8%) of the patients became pregnant, and 23 of these pregnancies had a live birth. The remaining pregnancies were ectopic (two), molar (one), or followed by an early miscarriage (six).
Of pregnancies, most occur after the introduction of medical assistance (eg IVF); seven of them (21.8%) occurred without additional medical intervention. The average time between surgery and conception was 11.1 months.
The researchers constructed statistical models in order to compare women who did get pregnant to those who did. They found three variables that were significantly associated with a lower likelihood of conception: having ovarian surgery, being 35 or older, and having a lower endometriosis stage.
Overall, this study shows a relatively high rate of pregnancies (and births) among women with endometriosis who have struggled with conception after undergoing surgery. This suggests that post-surgery pregnancy should be fully considered, even in cases that might seem to suggest otherwise.
The researchers said, “Many of our patients had four IVF procedures or were on the waiting list for oocyte donation and eventually had to undergo surgery to relieve their pain after giving up any hope of pregnancy. For these reasons, our results may encourage surgeons to do their best to maintain the uterus even in women who ‘have no hope of getting pregnant.’ ”
They concluded: “These encouraging results of experienced surgical teams working hand-in-hand with assisted reproductive techniques teams in multidisciplinary expert centers suggest that this is the way forward.”