title: Determining the fertility benefit of controlled ovarian hyperstimulation with intrauterine insemination after operative laparoscopy in patients with endometriosis.
abstract: OBJECTIVE
  To determine the fertility benefit of controlled ovarian hyperstimulation (COH) and intrauterine insemination (IUI) in surgically treated endometriosis.
  
  
  METHODS
  Retrospective cohort study (Canadian Task Force classification II-2).
  
  
  METHODS
  Cleveland Clinic Foundation, tertiary care center.
  
  
  METHODS
  Ninety-six women of reproductive age who underwent operative laparoscopy to treat endometriosis-related infertility (endometriosis stage I/II n = 67; stage III/IV n = 29) from 2001 to 2011 at the Cleveland Clinic Foundation.
  
  
  METHODS
  COH via letrozole, clomiphene, or gonadotropins, with or without IUI.
  
  
  RESULTS
  Kaplan-Meier estimations of cumulative pregnancy rates were compared by stage between COH/IUI and spontaneous cycles. Patients with stage I/II endometriosis attempted spontaneous pregnancy for 669 months and 216 COH + IUI cycles, and patients with stage III/IV endometriosis attempted spontaneous pregnancy for 379 months and 74 COH + IUI cycles. Crude pregnancy rates were 45.7% in stage I/II and 40.5% in stage III/IV. Twelve-month cumulative pregnancy rates in stage I/II were 45% for spontaneous attempts and 42% for COH + IUI, and in stage III/IV were 20% for spontaneous attempts and 10% for COH + IUI (not significant). Cumulative pregnancy rates for COH/IUI in stage I/II were significantly higher than in stage III/IV. Monthly fecundity rates were 3.81% for stage I/II spontaneous, 4.59% for COH/IUI, 3.05% for stage III/IV spontaneous, and 1.68% for COH/IUI (not significant).
  
  
  CONCLUSIONS
  COH + IUI did not improve pregnancy rates in any stage of endometriosis. In stage III/IV we recommend postoperative in vitro fertilization.
authors.affiliation: Cleveland Clinic, Cleveland, Ohio; Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio.
authors.forename: Anjalika R
authors.initials: AR
authors.lastname: Gandhi
authors.affiliation: Department of Obstetrics and Gynecology, São Paulo University, São Paulo, Brazil.
authors.forename: Luiz Fernando
authors.initials: LF
authors.lastname: Carvalho
authors.affiliation: Cleveland Clinic, Cleveland, Ohio.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Nutter
authors.affiliation: Cleveland Clinic, Cleveland, Ohio; Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio. Electronic address: falcont@ccf.org.
authors.forename: Tommaso
authors.initials: T
authors.lastname: Falcone
mesh_terms: D000328:Adult; D004715:Endometriosis / Q000601:surgery*; D005260:Female; D006801:Humans; D007247:Infertility, Female / Q000601:surgery / Q000628:therapy*; D007315:Insemination, Artificial; D010535:Laparoscopy; D010062:Ovulation Induction; D011247:Pregnancy; D018873:Pregnancy Rate; D012189:Retrospective Studies
keywords: ASRM staging system; Controlled ovarian hyperstimulation; Endometriosis; Intrauterine insemination; Laparoscopy