Does surgical management of endometriosis within 6 months of an in vitro fertilization-embryo transfer cycle improve outcome?
OBJECTIVE
To assess the effect on cycle outcome of surgery for endometriosis performed in the 6 months prior to in vitro fertilization-embryo transfer (IVF-ET).


METHODS
Retrospective analysis of all patients with a primary diagnosis of endometriosis undergoing IVF-ET during 12 consecutive months. The setting included tertiary care assisted reproductive technology program. Ninety-five consecutive cycles in candidates for autologous IVF-ET who had undergone surgical resection of endometriosis within 60 months of oocyte retrieval were evaluated. Five patients with persistent or recurrent endometriomas > 3 cm at the time of IVF-ET were excluded. Patients were divided into two groups based on the interval between the most recent surgical intervention and oocyte aspiration-Group I: < or = 6 months' interval (19 cycles); Group II: > 6 months' interval (76 cycles).


RESULTS
Mean intervals between surgery and oocyte aspiration were significantly different between the groups (Gr I: 3.7 +/- 0.3 months; Gr II: 21.8 +/- 1.6 months; p < 0.001). There were no significant differences between groups with regards to age, extent of endometriosis, or results of ovarian stimulation and oocyte aspiration. Ongoing pregnancy rates (Gr I: 63.2%; Gr. II: 60.5%) were similar. Regression analyses revealed no correlation between implantation rates and either endometriosis score (r = -0.09) or surgery-oocyte aspiration interval (r = -0.13).


CONCLUSIONS
The interval between surgical management of endometriosis and oocyte aspiration did not have an impact on IVF-ET cycle outcome in the absence of significant persistent or recurrent ovarian disease. Any effect of surgery on enhancing spontaneous conception may be overcome by the inherently greater impact of IVF-ET on implantation and pregnancy.
Surrey
Eric S
ES
Colorado Center for Reproductive Medicine, Englewood, Colorado, USA. esurrey@colocrm.com
Schoolcraft
William B
WB
D004624:Embryo Transfer; D004715:Endometriosis / Q000601:surgery*; D005260:Female; D005307:Fertilization in Vitro; D006801:Humans; D009865:Oocytes / Q000502:physiology; D011247:Pregnancy; D011256:Pregnancy Outcome; D018873:Pregnancy Rate; D012189:Retrospective Studies; D013997:Time Factors