Does surgery for deep infiltrating endometriosis improve pregnancy rates?

This study investigated pregnancy rates after surgery for deep infiltrating endometriosis (DIE). 

They found that surgery for DIE improves pregnancy rates in these women.

Endometriosis (EDM) is a common cause of infertility. EDM is caused by uterine tissue growing outside the uterus. This tissue is called endometrium. This can cause severe pain. Deep infiltrating endometriosis (DIE) is a more severe form of EDM. It is caused by uterine tissue growing in areas like the colon and rectum. DIE is associated with higher pain and infertility. Surgery can be used to treat DIE. This can help improve pain. It may also have benefits for fertility. 

Assisted reproduction (AR) is more difficult in patients with DIE. AR includes techniques like in vitro fertilization (IVF). Some doctors refer patients for AR before surgery. Some guidelines suggest surgery may improve spontaneous pregnancy rates. However, some guidelines state that it is not useful in improving IVF outcomes. It is unclear if pregnancy rates are higher after surgery for DIE. 

This study included 104 women that underwent DIE surgery. These women also had at least 2 failed AR attempts. The authors analyzed pregnancy rates in these women. American Fertility Society (AFS) scores were used to measure EDM. AFS scores can also predict if EDM will recur. 

73 women tried to conceive after surgery. 32 patients (43.8%) became pregnant after surgery. 7 (21.8%) of these women had a spontaneous pregnancy after surgery. 10 women achieved pregnancy by IVF and 7 by frozen embryo transfer. 6 women conceived after intracytoplasmic sperm injection (ICSI). 1 patient conceived after intrauterine insemination (IUI).

The average time from surgery to pregnancy was 11.1 months. Women that did not become pregnant had higher AFS scores. Factors associated with a lower chance for obtaining a pregnancy were ovarian surgery, age of 35 and higher and a lower EDM stage (I or II).

The authors concluded that surgery for DIE improved pregnancy outcomes in women who failed previous AR techniques.

This was a retrospective study meaning it looked back at medical records. Some patient data was not available. There was no comparison to other treatments or control. More studies are needed. 

If you have any concerns regarding infertility management please consult with your physician.