High fertility rate after surgery for colorectal endometriosis

Last Updated: 2018-08-16

By Will Boggs MD

NEW YORK (Reuters Health) - The fertility rate after surgical management of colorectal endometriosis exceeds 80%, researchers from France report.

"To date, a majority of colleagues say, 'Oh, you have a huge endometriosis; the surgery is challenging and may render you infertile, due to either ovarian failure or postoperative complications; it is much better to undergo IVF and to postpone the surgery (or not to do surgery at all),'" Dr. Horace Roman from Rouen University Hospital told Reuters Health by email. "Our results show that these beliefs have no scientific support."

For women with severe colorectal endometriosis who desire pregnancy, it remains controversial whether the optimal first-line therapy is surgery or advanced reproductive therapy (ART), such as in vitro fertilization (IVF).

Dr. Roman's team assessed fertility outcomes in 36 women who participated in a randomized trial comparing conservative rectal surgery versus segmental resection for deep endometriosis infiltrating the rectum. The women intended to get pregnant during follow-up, including the 23 who were infertile (i.e., tried to get pregnant without success for more than 12 months before surgery).

At the end of follow-up, which ranged from 50 to 79 months, 29 women (81%) had achieved pregnancy, with 59% of conceptions occurring naturally and 41% using ART techniques, the researchers report in Human Reproduction, online July 25.

Among the previously infertile women, 17 (74%) achieved pregnancy, including nine who conceived naturally.

Two of the seven women with conception failure had preoperative ovarian failure, two with normal ovarian reserve are currently undergoing ART management, one woman with normal ovarian reserve had unsuccessful natural conception and is scheduled for IVF, and one has attempted natural conception for six months with no success and has no intention for ART management.

The cumulative probabilities of achieving pregnancy postoperatively were 33% at 12 months, 61% at 24 months, 77% at 36 months and 87% at 48 months.

"Our study shows that both surgery and pregnancy are very often possible," the researchers note. "It also highlights the advisory role of the surgeon regarding the likelihood of natural conception and pregnancy after surgery and whether ART really is necessary."

"Physicians should ultimately offer patients a balanced perspective of the potential benefits and potential harms of alternative options, including considerations on the strength of the available evidence supporting them, in order to help them in choosing the best strategy adapted to their goals, symptoms and beliefs," they conclude.

"Management of such young patients should be individualized; however, advice should be asked from surgeons experienced in this surgery (and not from a friend who simply performs gynecological surgery)," Dr. Roman said. "This article ultimately recommends the creation of expert centers with skilled surgeons and ART specialists with good knowledge in severe deep endometriosis, which may provide the best results in this challenging disease."

SOURCE: https://bit.ly/2OGi5kq

Human Reprod 2018.