title: Reproductive performance in infertile women with rectovaginal endometriosis: is surgery worthwhile?
abstract: OBJECTIVE
  This study was undertaken to ascertain whether the incidence of pregnancy is increased and time-to-conception is reduced in infertile women with rectovaginal endometriosis undergoing conservative surgery compared with those on expectant management.
  
  
  METHODS
  A total of 105 infertile women under the age of 40 years with rectovaginal endometriosis and no other associated major infertility factor underwent first-line conservative surgery at laparotomy or expectant management according to a shared decision-making approach.
  
  
  RESULTS
  Among the 44 women who had resection of rectovaginal endometriosis, 15 became pregnant, compared with 22 of the 61 women who choose expectant management (24-month cumulative probabilities, 44.9% and 46.8%, respectively; log-rank test, chi2(1) = 0.75; P = .38). One major and 9 minor postoperative complications occurred. Significant differences in pain-free survival time in favor of the surgery group were observed for dysmenorrhea, dyspareunia, and dyschezia.
  
  
  CONCLUSIONS
  Conservative surgery for rectovaginal endometriosis in infertile women does not modify the reproductive prognosis although it does increase pain-free survival time.
authors.affiliation: Benign Gynecologic Surgery Unit, Clinica Ostetrica e Ginecologica II, University of Milan, Istituto Luigi Mangiagalli, Milan, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Vercellini
authors.forename: Giuliana
authors.initials: G
authors.lastname: Pietropaolo
authors.forename: Olga
authors.initials: O
authors.lastname: De Giorgi
authors.forename: Raffaella
authors.initials: R
authors.lastname: Daguati
authors.forename: Roberta
authors.initials: R
authors.lastname: Pasin
authors.forename: Pier Giorgio
authors.initials: PG
authors.lastname: Crosignani
mesh_terms: D000328:Adult; D004715:Endometriosis / Q000150:complications / Q000601:surgery*; D005260:Female; D013509:Gynecologic Surgical Procedures; D006801:Humans; D007247:Infertility, Female / Q000150:complications / Q000503:physiopathology*; D010166:Palliative Care; D011247:Pregnancy; D018873:Pregnancy Rate; D011379:Prognosis; D012002:Rectal Diseases / Q000150:complications / Q000601:surgery*; D012098:Reproduction; D016019:Survival Analysis; D014623:Vaginal Diseases / Q000150:complications / Q000601:surgery*