RESEARCH PAPER
Effectiveness of laparoscopic surgeries in treating infertility related to endometriosis
 
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I Department of Obstetrics and Gynaecology, Medical Centre of Postgraduate Education, Warsaw, Poland
 
 
Ann Agric Environ Med. 2015;22(2):329-331
 
KEYWORDS
ABSTRACT
Introduction:
Endometriosis is defined as an illness caused by the presence of foci of endometrial tissue outside the uterine cavity. The illness is found in 5–10% of women at reproductive age. In the group of those suffering from endometriosis, the percentage of infertile women amounts to 50%. At higher stages of endometriosis clinical advancement, the suggested treatment is the application of assisted reproductive technology.

Objective:
The aim of the study was assessment of the effectiveness of laparoscopy in treating infertility related to endometriosis among women treated in our clinic in 2009–2012.

Material and Methods:
The clinic is a medical centre focused on advanced minimally invasive surgical treatment, especially laparoscopic surgeries in diseases of the uterus – with a focus on laparoscopic surgeries for patients with endometriosis of the recto-vaginal area. 53 female patients treated for infertility who underwent a laparoscopic surgical procedure to remove the foci of endometriosis in 2009–2012, were analysed retrospectively. After the surgical procedure, the patients were observed over a period of 12 months, during which the frequency of pregnancies (including natural and assisted pregnancies) was assessed in relation to the stage of endometriosis advancement (rAFS).

Results:
In 17 out of 53 (32%) patients who underwent the surgical procedure a clinical pregnancy was diagnosed. 11 out of 53 (20.75%) women became pregnant spontaneously, 6 out of 53 (11.32%) patients became pregnant as a result of assisted reproductive technology (ART) (5 IVF and 1 IUI). The average time from the date of surgical procedure to spontaneous pregnancy amounted to 6 months.

Conclusions:
Laparoscopy is a vital therapeutic method. Operative laparoscopy is an efficient method for treating infertility related to endometriosis, and the procedure seems to be the most effective particularly at stage III rAFS. The period for expectant management after a surgical procedure should last 6 months.

 
REFERENCES (31)
1.
Giudice LC. Endometriosis. Lancet 2004; 364: 1789–1799.
 
2.
Burney RO, Giudice LC. Pathogenesis and pathophysiology of endometriosis. Fertil Steril. 2012; 98 (3): 511–519.
 
3.
Bischoff FZ, Simpson JL. Heritability and molecular genetic studies of endometriosis. Hum Reprod Update. 2000; 6: 37–44.
 
4.
Adamson G, Baker V. Subfertility: causes, treatment and outcome. Best Pract Res Clin Obstet Gynaecol. 2003; 17: 169–185.
 
5.
Counsellor VS. Endometriosis. A clinical and surgical review. Am J Obstet Gynecol. 1938; 36: 877.
 
6.
Wei Q, Clair JB, Fu T, et al. Reduced expression of biomarkers associated with the implantation window in women with endometriosis. Fertil Steril. 2009; 91: 1686–1691.
 
7.
Arici A, Oral E, Bukulmez O. The effect of endometriosis on implantation. Result from the Yale University in vitro fertilization and embryo transfer program. Fertil Steril. 1996; 65: 603–607.
 
8.
Hahn D, Carraher R, Foldesy R. Experimental evidence for failure to implant as a mechanism of infertility associated with endometriosis. Am J Obstet Gynecol. 1986; 155: 1109–1113.
 
9.
Mansour G, Aziz N, Sharma R, et al. The impact of peritoneal fluid from healthy women and from women with endometriosis on sperm DNA and its relationship to the sperm deformity index. Fertil Steril. 2009; 92: 61–67.
 
10.
Kennedy S, Bergqvist A, Chapron C, et. al. ESHRE guideline for the diagnosis and treatment of endometriosis. Hum Reprod. 2005; 20(10): 2698–2704.
 
11.
Nayak PK, Mahapatra PC, Mallick J, et. al. Role of diagnostic hystero-laparoscopy in the evaluation of infertility: A retrospective study of 300 patients. J Hum Reprod Sci. 2013; 6 (1): 32–34.
 
12.
National Collaborating Centre for Women’s and Children’s Health. Fertility: assessment and treatment for people with fertility problems. London, RCOG Press, 2004. www.nice.org.uk/ page (access: 2013.08.20).
 
13.
Hughes E, Fedorkow D, Collins J, Vandekerckhove P. Ovulation suppression for endometriosis. Cochrane Database Syst Rev. 2000; 3: CD000155.
 
14.
Drews K, Barlik M, Łukaszewski T. Leczenie zachowawcze endometriozy. Ginekol Pol. 2012; 83: 209–213 (in Polish).
 
15.
The Practice Committee of the American Society for Reproductive Medicine. Endometriosis and infertility. Fertil Steril. 2006; 86(Supl. 4): 156–160.
 
16.
Deguara CS, Pepas L, Davis C, Does minimally invasive surgery for endometriosis improve pelvic symptoms and quality of life? Curr Opin Obstet Gynecol. 2012; 24(4): 241–244.
 
17.
Bonneau C, Chanelles O, Sifer C, et. al. Use of laparoscopy in unexplained infertility. Eur J Obstet Gynecol Reprod Biol. 2012; 163(1): 57–61.
 
18.
Meuleman C, Tomassetti C, Gaspar Da Vitoria Magro M, et. al. Laparoscopic treatment of endometriosis. Minerva Ginecol. 2013; 65 (2): 125–142.
 
19.
American Society for Reproductive Medicine. Revised American Society for Reproductive Medicine classification of endometriosis: 1996. Fertil Steril 1997; 67: 817–821.
 
20.
Adamson GD, Pasta DJ. Endometriosis fertility index: the new, validated endometriosis staging system. Fertil Steril. 2010; 94 (5): 1609–1615.
 
21.
Guzick DS, Sillian NP, Adamson GD, et al. Prediction of pregnancy in infertile women based on the American Society for Reproductive Medicine›s revised classification of endometriosis. Fertil Steril. 1997; 67: 822–829.
 
22.
Jacobson T, Barlow D, Koninckx P, et al. Laparoscopic surgery for subfertility associated with endometriosis. Cochrane Database Syst Rev. 2002; 4: CD001398; Update: Cochrane Database Syst Rev. 2010; 1: CD001398.
 
23.
Marcoux S, Maheux R, Berube S. Laparoscopic surgery in infertile women with minimal or mild endometriosis. Canadian Collaborative Group on Endometriosis. N Engl J Med. 1997; 337: 217–222.
 
24.
Practice Committee of the American Society for Reproductive Medicine. Endometriosis and infertility: a committee opinion. Fertil Steril. 2012; 98(3): 591–598.
 
25.
Tinkanen H, Kujansuu E. In vitro fertilization in patients with ovarian endometriomas. Acta Obstet Gynecol Scand. 2000; 79: 119–122.
 
26.
Cooper TG, Noonan E, von Eckardstein S, et. al.. World Health Organization reference values for human semen characteristics. Hum Reprod Update 2010; 16 (3): 231–245.
 
27.
Vercellini P, Somigliana E, Vigano P, et. al. Surgery for endometriosis – associated infertility: a pragmatic approach. Hum Reprod. 2009; 24(2): 254–269.
 
28.
Berlanda N, Vercellini P, Somigliana E, et. al. Role of Surgery in Endometriosis-Associated Subfertility. Semin Reprod Med. 2013; 31(2): 133–143.
 
29.
Jędrzejczak P, Sokalska A, Spaczyński R, et.al. Effects of presacral neurectomy on pelvic pain in women with and without endometriosis. Ginekol Pol. 2009; 80: 172–178.
 
30.
D’Hooghe TM, Debrock S, Hill JA, et. al. Endometriosis and subfertility: is the relationship resolved? Semin Reprod Med. 2003; 21: 243–254.
 
31.
De Ziegler D, Borghese B, Chapron C, Endometriosis and infertility: pathophysiology and management. Lancet 2010; 376: 730–738.
 
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ISSN:1232-1966
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