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Fertil Steril. 2017 Sep;108(3):525-531.e4. doi: 10.1016/j.fertnstert.2017.07.002. Epub 2017 Aug 12.

Colorectal endometriosis-associated infertility: should surgery precede ART?

Author information

1
Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris, University Pierre and Marie Curie, Institut Universitaire de Cancérologie, Paris, France; INSERM UMRS 707, Epidemiology, Information Systems, Modeling, University Pierre and Marie Curie, Paris, France. Electronic address: sofiane.bendifallah@aphp.fr.
2
Expert Center in the Diagnosis and Multidisciplinary Management of Endometriosis, Department of Gynecology and Obstetrics, Rouen University Hospital, Rouen, France.
3
Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris, University Pierre and Marie Curie, Institut Universitaire de Cancérologie, Paris, France.
4
Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris, University Pierre and Marie Curie, Institut Universitaire de Cancérologie, Paris, France; UMRS 938 Université Pierre et Marie Curie, Paris, France; Groupe de Recherche Clinique GRC6-UPMC, Centre Expert En Endométriose, Paris, France.

Abstract

OBJECTIVE:

To compare the impact of first-line assisted reproductive technology (ART; intracytoplasmic sperm injection [ICSI]-IVF) and first-line colorectal surgery followed by ART on fertility outcomes in women with colorectal endometriosis-associated infertility.

DESIGN:

Retrospective matched cohort study using propensity score (PS) matching (PSM) analysis.

SETTING:

University referral centers.

PATIENT(S):

A total of 110 women were analyzed from January 2005 to June 2014. A PSM was generated using a logistic regression model based on the age, antimüllerian hormone (AMH) serum level, and presence of adenomyosis to compare the treatment strategy.

INTERVENTION(S):

First-line surgery group followed by ART versus exclusive ART with in situ colorectal endometriosis.

MAIN OUTCOME MEASURE(S):

After PSM, pregnancy rates (PRs), live-birth rates (LBRs), and cumulative rates (CRs) were estimated.

RESULT(S):

After PSM, in the whole population, the total LBR and PR were 35.4% (39/110) and 49% (54/110), respectively. The specific cumulative LBR at the first ICSI-IVF cycle in the first-line surgery group compared with the first-line ART was, respectively, 32.7% versus 13.0%; at the second cycle, 58.9% versus 24.8%; and at the third cycle, 70.6% versus 54.9%. The cumulative LBRs were significantly higher for women who underwent first-line surgery followed by ART compared with first-line ART in the subset of women with good prognosis (age ≤ 35 years and AMH ≥ 2 ng/mL and no adenomyosis) and women with AMH serum level < 2 ng/mL.

CONCLUSION(S):

First-line surgery may be a good option for women with colorectal endometriosis-associated infertility.

KEYWORDS:

ART; Colorectal endometriosis; infertility; propensity score (PS) matching (PSM); surgery

[Indexed for MEDLINE]

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