title: Pregnancy rate in endometriosis patients according to the severity of the disease after using a combined approach of laparoscopy, GnRH agonist treatment and in vitro fertilization.
abstract: OBJECTIVE
  To evaluate the effects of combined treatment approaches on endometriosis-associated infertility in different stages of endometriosis using laparoscopy, gonadotropin-releasing hormone (GnRH) agonist (GnRHa) therapy and in vitro fertilization (IVF).
  
  
  METHODS
  This retrospective study was carried out on 179 women with surgically confirmed endometriosis. Patients were divided into subgroups: group 1 (stage I-II, n = 121) and group 2 (stage III-IV, n = 58). Patients eligible for IVF, who were found to have adenomyosis or moderate to severe endometriosis, were also given postoperative GnRHa. Pregnancy and delivery rates were cumulatively calculated during 5 years according to the severity of the disease.
  
  
  RESULTS
  The overall pregnancy, delivery and miscarriage rates were 66.5, 56.4 and 15.1%, respectively, for all patients following spontaneous and assisted conception. There were no significant differences in reproductive outcomes between the study groups. The pregnancy and delivery rates were also comparable within group 1 between the patients with and without GnRHa treatment.
  
  
  CONCLUSIONS
  Pregnancy and delivery rates at different stages of endometriosis were not affected by the different approaches used for infertility treatment, with >60 and >50% of patients having conceived and delivered a baby, respectively, in both groups. The usefulness of GnRHa treatment for endometriosis patients with minimal to mild forms is questionable and deserves further studies.
authors.affiliation: Women's Clinic of Tartu University Hospital, Tartu, Estonia.
authors.forename: Deniss
authors.initials: D
authors.lastname: Sõritsa
authors.forename: Merli
authors.initials: M
authors.lastname: Saare
authors.forename: Triin
authors.initials: T
authors.lastname: Laisk-Podar
authors.forename: Maire
authors.initials: M
authors.lastname: Peters
authors.forename: Andrei
authors.initials: A
authors.lastname: Sõritsa
authors.forename: Kadri
authors.initials: K
authors.lastname: Matt
authors.forename: Helle
authors.initials: H
authors.lastname: Karro
authors.forename: Andres
authors.initials: A
authors.lastname: Salumets
mesh_terms: D000022:Abortion, Spontaneous / Q000453:epidemiology; D000328:Adult; D004715:Endometriosis / Q000150:complications* / Q000188:drug therapy / Q000601:surgery; D005260:Female; D005307:Fertilization in Vitro; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists*; D017273:Goserelin / Q000008:administration & dosage; D006801:Humans; D007247:Infertility, Female / Q000209:etiology / Q000628:therapy*; D010535:Laparoscopy; D011247:Pregnancy; D011248:Pregnancy Complications; D011256:Pregnancy Outcome; D018873:Pregnancy Rate; D012189:Retrospective Studies
chemical_list: D017273:Goserelin; D007987:Gonadotropin-Releasing Hormone