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Indexed/Abstracted in: EMBASE, PubMed/MEDLINE, Scopus, Emerging Sources Citation Index
Maria C. CESANA 1, Luisa FERRARI 2, Paolo PASSONI 2, Serena POLIZZI 1, Federica BRUNETTI 1, Rodolfo MILANI 2
1 Bicocca University of Milan, Milan, Italy; 2 Division of Gynecology, San Gerardo Hospital of Monza, Monza, Italy
BACKGROUND: To evaluate the reproductive prognosis in women subjected to conservative surgical treatment for endometriosis seeking pregnancy during the first three years after surgery. We tried to identify operative findings which negative influences prognosys.
METHODS: We retrospectively analysed 140 patients with a diagnosis of endometriosis, based on surgical and histological criteria and without other male or female infertility factors who underwent surgery between 01/2002 and 01/2012. For each patient anatomo/surgical data, stage according to the revised classification of American Fertlity Society (AFS), months of pregnancy research and the use of assisted reproduction technology (ART) after surgery were registrated. 109 patients had been diagnosed preoperatively as being infertile (group 1), 31 cases tried to conceive only after surgery (group 2). The study was approved by the Ethics Committee of San Gerardo Hospital-Monza.
RESULTS: The pregnancy rate among infertile women (group 1) was 53% (58/109, 48 occurring naturally and 10 with ART), and 71% (22/31, 3 with ART) in patients of group 2.
The overall cumulative probability of pregnancy at 3 years was 60% for group 1 and 76% for group 2. The prognosis was indipendent by the stage, presence of monolateral or bilateral endometriomas, tubaric adhesions or superficial lesions while it is inversely correlated to pouch of Douglas obliteration (POD) (p value 0.05).
CONCLUSIONS: Surgery improves the reproductive prognosys in infertile women with endometriosis. In the studied population POD obliteration had a high prevalence and it influenced negatively the pregnancy outcome.