title: Endometriosis and infertility Surgery and ART: An integrated approach for successful management.
abstract: OBJECTIVE
  Laparoscopy is considered the gold standard for treatment of endometriosis. In vitro fertilization and embryo transfer (IVF-ET) is often used to treat women with infertility associated with endometriosis. The objective of the study was to evaluate the pregnancy rate after surgical treatment and to assess whether a combined approach with laparoscopic surgery followed by IVF-ET can improve the "overall" pregnancy rate.
  
  
  METHODS
  A retrospective observational study was carried out on 107 infertile patients who underwent laparoscopic surgery for endometriosis and came at follow-up for a period of time between 1 and 11 years. Sixty-seven patients who did not become pregnant after surgery subsequently underwent IVF-ET.
  
  
  RESULTS
  The pregnancy rate achieved after the integrated laparoscopy-IVF approach was 56.1%. The pregnancy rate after surgery, was significantly lower (37.4%). The fecundity rate for spontaneous conceptions within 6 months of laparoscopy (23.2%) was significantly higher (P<0.05) than for the following intervals. The cumulative fecundity in women older than 35 years was significantly lower than in younger women.
  
  
  CONCLUSIONS
  In patients with endometriosis-associated infertility, surgery followed by IVF-ET is more effective than surgery alone. When patients fail to conceive spontaneously, after a maximum of 1 year from laparoscopic surgery, IVF should be suggested.
authors.affiliation: Department of Gynaecology, Perinatology and Human Reproduction, University of Florence, Florence, Italy. cocciame@tin.it
authors.forename: M Elisabetta
authors.initials: ME
authors.lastname: Coccia
authors.forename: Francesca
authors.initials: F
authors.lastname: Rizzello
authors.forename: Fiamma
authors.initials: F
authors.lastname: Cammilli
authors.forename: Gian Luca
authors.initials: GL
authors.lastname: Bracco
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Scarselli
mesh_terms: D000328:Adult; D004624:Embryo Transfer; D004715:Endometriosis / Q000150:complications / Q000601:surgery*; D005260:Female; D005307:Fertilization in Vitro; D013509:Gynecologic Surgical Procedures; D006801:Humans; D007247:Infertility, Female / Q000209:etiology / Q000601:surgery*; D010535:Laparoscopy; D011247:Pregnancy; D018873:Pregnancy Rate; D027724:Reproductive Techniques, Assisted; D012189:Retrospective Studies