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01-07-2015 | Gynecologic Endocrinology and Reproductive Medicine

Could surgeon’s expertise resolve the debate about surgery effectiveness in treatment of endometriosis-related infertility?

Authors: Salvatore Gizzo, Lorena Conte, Stefania Di Gangi, Concetta Leggieri, Michela Quaranta, Marco Noventa, Pietro Litta, Carlo Saccardi

Published in: Archives of Gynecology and Obstetrics | Issue 1/2015

Abstract

Purpose

Restoring the anatomical relationship and preserving the function of pelvic organs represent the ideal outcome of surgical intervention in patients suffering from endometriosis-related infertility. The aim of the study was to compare two large cohorts (Group A and Group B) of infertile patients in terms of postsurgical spontaneous/assisted fertility and perioperative surgical outcomes. The surgical treatment was performed by a skilled surgeon (Group A) and a surgeon dedicated to endometriosis-related infertility (Group B).

Methods

An observational cohort study on women affected by pelvic endometriosis who underwent laparoscopic treatment (to restore/improve their fertility) was conducted. A comparison, between Group A and Group B, in terms of perioperative surgical outcomes, clinical/ongoing pregnancy and live birth rates, spontaneous pregnancy rate and obstetrical outcome was performed.

Results

A significantly higher spontaneous fertility rate (particularly in the first year after surgery) and lower ectopic pregnancy rate were found in Group B. ART success rates were not affected by different surgical approaches. Perioperative and obstetrical outcomes were similar in both groups.

Conclusion

In patients affected by endometriosis, the choice between expectant management versus intervention should be personalized: when the estimated probability of natural conception is low, surgery may be considered as a second-line treatment. Conversely, in all other cases surgery should be offered early (as a first-line approach) as it improves the chance of spontaneous conception. The laparoscopic treatment of infertility due to endometriosis must be performed by a skilled specialized surgeon to ensure a complete “pelvic cleanout” while respecting the anatomical structures and reducing the risk of fertility impairment due to surgical procedures.

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Title: Could surgeon’s expertise resolve the debate about surgery effectiveness in treatment of endometriosis-related infertility?
Authors: Salvatore Gizzo
Lorena Conte
Stefania Di Gangi
Concetta Leggieri
Michela Quaranta
Marco Noventa
Pietro Litta
Carlo Saccardi
Publication date: 01-07-2015
Publisher: Springer Berlin Heidelberg
Published in: Archives of Gynecology and Obstetrics / Issue 1/2015
Print ISSN: 0932-0067
Electronic ISSN: 1432-0711
DOI: https://doi.org/10.1007/s00404-014-3591-z

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Could surgeon’s expertise resolve the debate about surgery effectiveness in treatment of endometriosis-related infertility?

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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