title: Could surgeon's expertise resolve the debate about surgery effectiveness in treatment of endometriosis-related infertility?
abstract: OBJECTIVE
  Restoring the anatomical relationship and preserving the function of pelvic organs represent the ideal outcome of surgical intervention in patients suffering from endometriosis-related infertility. The aim of the study was to compare two large cohorts (Group A and Group B) of infertile patients in terms of postsurgical spontaneous/assisted fertility and perioperative surgical outcomes. The surgical treatment was performed by a skilled surgeon (Group A) and a surgeon dedicated to endometriosis-related infertility (Group B).
  
  
  METHODS
  An observational cohort study on women affected by pelvic endometriosis who underwent laparoscopic treatment (to restore/improve their fertility) was conducted. A comparison, between Group A and Group B, in terms of perioperative surgical outcomes, clinical/ongoing pregnancy and live birth rates, spontaneous pregnancy rate and obstetrical outcome was performed.
  
  
  RESULTS
  A significantly higher spontaneous fertility rate (particularly in the first year after surgery) and lower ectopic pregnancy rate were found in Group B. ART success rates were not affected by different surgical approaches. Perioperative and obstetrical outcomes were similar in both groups.
  
  
  CONCLUSIONS
  In patients affected by endometriosis, the choice between expectant management versus intervention should be personalized: when the estimated probability of natural conception is low, surgery may be considered as a second-line treatment. Conversely, in all other cases surgery should be offered early (as a first-line approach) as it improves the chance of spontaneous conception. The laparoscopic treatment of infertility due to endometriosis must be performed by a skilled specialized surgeon to ensure a complete "pelvic cleanout" while respecting the anatomical structures and reducing the risk of fertility impairment due to surgical procedures.
authors.affiliation: Department of Woman and Child Health, University of Padua, Padua, Italy, ginecologia_padova@libero.it.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Gizzo
authors.forename: Lorena
authors.initials: L
authors.lastname: Conte
authors.forename: Stefania
authors.initials: S
authors.lastname: Di Gangi
authors.forename: Concetta
authors.initials: C
authors.lastname: Leggieri
authors.forename: Michela
authors.initials: M
authors.lastname: Quaranta
authors.forename: Marco
authors.initials: M
authors.lastname: Noventa
authors.forename: Pietro
authors.initials: P
authors.lastname: Litta
authors.forename: Carlo
authors.initials: C
authors.lastname: Saccardi
mesh_terms: D000328:Adult; D015331:Cohort Studies; D004715:Endometriosis / Q000150:complications / Q000601:surgery*; D005260:Female; D005298:Fertility; D006801:Humans; D007247:Infertility, Female / Q000209:etiology / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D011247:Pregnancy; D018873:Pregnancy Rate; D011271:Pregnancy, Ectopic / Q000453:epidemiology; D066231:Surgeons / Q000592:standards*