Management of stage III and IV endometriosis: a 10-year experience.
A retrospective analysis is reported of the management of 117 cases of infertility associated with Stage III and IV endometriosis. Combined medico-microsurgical treatment was selected in 75.3% of Stage III cases and in 83.3% of those on Stage IV. Medication consisted of medroxyprogesterone acetate in 26 patients and danazol in the remaining 64. Microsurgery alone was utilized in 24.7% of Stage III patients and in 16.6% of those on Stage IV. Both surgery alone and the combined therapy had a profound positive effect on subjective symptoms: dysmenorrhea, dyspareunia and pelvic pain. Following combined therapy, pregnancy was achieved in 34.4% of all women. Respective figures are 30.7% for medroxyprogesterone acetate (29.4% Stage III and 33.3% Stage IV) and 35.9% for danazol (37.7% Stage III and 27.2% Stage IV). In the group of patients treated by surgery alone, pregnancy occurred in 25.9%. Of the pregnancies in women with Stage III endometriosis, 25 were carried to term and 6 ended with a spontaneous abortion; figures for Stage IV women are 5 and 2, respectively. Second-look laparoscopy was performed in 49 of the 79 patients who failed to conceive, at 12-36 months after treatment; persistent genital pathology, to which infertility could be attributed, was found in 77.5% of them.
Napolitano
C
C
First Institute of Gynaecology and Obstetrics, University La Sapienza, Rome, Italy.
Marziani
R
R
Mossa
B
B
Perniola
L
L
Benagiano
G
G
D003131:Combined Modality Therapy; D003613:Danazol / Q000008:administration & dosage / Q000627:therapeutic use; D004715:Endometriosis / Q000150:complications* / Q000601:surgery / Q000628:therapy; D005260:Female; D006801:Humans; D007247:Infertility, Female / Q000209:etiology / Q000601:surgery / Q000628:therapy*; D010535:Laparoscopy; D017258:Medroxyprogesterone Acetate / Q000008:administration & dosage / Q000627:therapeutic use; D008599:Menstruation Disturbances; D008866:Microsurgery; D010146:Pain; D011247:Pregnancy; D012086:Reoperation; D012189:Retrospective Studies
D017258:Medroxyprogesterone Acetate; D003613:Danazol