title: Comparison of reoperation for moderate (stage III) and severe (stage IV) endometriosis-related infertility with in vitro fertilization-embryo transfer.
abstract: OBJECTIVE
  To evaluate the efficacy of reoperation for stage III or IV endometriosis-related infertility versus IVF-ET.
  
  
  METHODS
  Retrospective analysis.
  
  
  METHODS
  In vitro fertilization-embryo transfer unit and tertiary infertility clinic.
  
  
  METHODS
  Twenty-three couples with stage III or IV endometriosis-related infertility undergoing IVF-ET and 18 women undergoing reoperation for stage III or IV disease, both groups undergoing treatment after failed initial surgery to restore fertility.
  
  
  RESULTS
  The cumulative pregnancy rate (CPR) after reoperation for stage III or IV endometriosis-related infertility after 3, 7, and 9 months was 5.9 percent, 18.1 percent and 24.4 percent, respectively. The cumulative PR after one and two cycles of IVF-ET with stage III or IV endometriosis was 33.3 percent and 69.6 percent, respectively. The cumulative PR after one cycle of IVF-ET was higher than with reoperation 33.3 percent versus 24.4 percent. After two cycles the cumulative PR was significantly higher than reoperation 69.6 percent versus 24.4 percent. The mean number of oocytes retrieved was 8.5 +/- 4.6, the mean number of embryos was 4.8 +/- 2.9, and the fertilization rate was 64 percent +/- 21.8 percent. The PR per cycle, per oocyte retrieval and per ET was 38 percent, 42 percent, and 44 percent, respectively, with the implantation rate being 16 percent. The live birth rate per oocyte retrieval and per ET was 29.7 percent and 34.4 percent, respectively. No statistically significant difference could be demonstrated with regard to the fertilization, implantation, nor pregnancy or live birth rates, as compared with IVF-ET outcome with tubal infertility.
  
  
  CONCLUSIONS
  If initial surgery fails to restore fertility in patients with moderate (stage III) or severe (stage IV) endometriosis-related infertility, IVF-ET is an effective alternative; reoperation for asymptomatic patients offers little added benefit.
authors.affiliation: Department of Obstetrics and Gynecology, McGill University, Montreal, Quebec, Canada.
authors.forename: K
authors.initials: K
authors.lastname: Pagidas
authors.forename: T
authors.initials: T
authors.lastname: Falcone
authors.forename: R
authors.initials: R
authors.lastname: Hemmings
authors.forename: P
authors.initials: P
authors.lastname: Miron
mesh_terms: D000328:Adult; D004624:Embryo Transfer; D004715:Endometriosis / Q000150:complications / Q000473:pathology / Q000601:surgery*; D005260:Female; D005307:Fertilization in Vitro; D006801:Humans; D007247:Infertility, Female / Q000209:etiology / Q000601:surgery* / Q000628:therapy*; D008297:Male; D011247:Pregnancy; D012086:Reoperation; D012189:Retrospective Studies