Women who have surgery for deep infiltrating endometriosis and want to get pregnant have a reasonably high chance of conception, even after multiple failed attempts at in vitro fertilization (IVF), a new study suggests.
The study, “Pregnancy rates after surgical treatment of deep infiltrating endometriosis in infertile patients with at least 2 previous IVF/ICSI failures,” was published in the Journal of Minimally Invasive Gynecology.
Endometriosis can cause infertility, and there has been debate about how to manage this for people who want to get pregnant — specifically, whether it is better to try assisted reproductive techniques (e.g. IVF) before or after surgery.
In the new study, researchers looked at clinical data from the CIRENDO database, which records such data for people with endometriosis who are managed at one of several clinics in France.
The researchers specifically looked at patients younger than 43 who had undergone at least two previous attempts at IVF, had endometriosis surgery, and stated a desire to become pregnant after the surgery.
The researchers identified records for 73 patients matching these criteria and with at least one year’s worth of post-surgical data. Most of these patients had stage IV endometriosis; the average number of previous IVF attempts was 3.7.
In the time that data was available, 32 (43.8%) of the patients became pregnant, and 23 of these pregnancies resulted in a live birth. The remaining pregnancies were ectopic (two), molar (one), or resulted in an early miscarriage (six).
Of the pregnancies, most occurred after the introduction of medical assistance (e.g. IVF); seven of them (21.8%) occurred without additional medical intervention. The average time between surgery and conception was 11.1 months.
The researchers constructed statistical models in order to compare the women who did get pregnant to those who didn’t. They found three variables that were significantly associated with a lower likelihood of conception: having ovarian surgery, being 35 or older, and having a lower endometriosis stage.
Overall, this study shows a fairly high rate of pregnancies (and births) among people with endometriosis who have struggled with conception after having undergone surgery. This suggests that post-surgery pregnancy should be considered fully possible, even in cases that might seem to suggest otherwise.
The researchers said, “Several of our patients had had up to four IVF procedures or were on the waiting list for oocyte donation and had finally turned to surgery to relieve their pain after having given up any hope of pregnancy. For these reasons, our results may encourage surgeons to do their best to maintain the uterus even in women who ‘have no more hope of getting pregnant.'”
They concluded: “These encouraging results of experienced surgical teams, working hand in hand with [assisted reproductive techniques] teams in multidisciplinary expert centers, suggest that this is the way forward.”