title: Recurrences and fertility after endometrioma ablation in women with and without colorectal endometriosis: a prospective cohort study.
abstract: OBJECTIVE
  What are the recurrence and pregnancy rates in women managed for ovarian endometrioma by ablation using plasma energy with and without associated surgery for colorectal endometriosis?
  
  
  CONCLUSIONS
  Concomitant management of colorectal endometriosis does not impact either risk of recurrences or probability of pregnancy in women managed for endometrioma ablation using plasma energy.
  
  
  BACKGROUND
  No consensus exists on how best to manage patients presenting with ovarian endometriomas and colorectal endometriosis, in terms of impact on fertility preservation and recurrence rates.
  
  
  METHODS
  A prospective series of consecutive patients managed for ovarian endometriomas by ablation using plasma energy, over a period of 48 consecutive months. The study included patients with associated colorectal endometriosis (n = 52) and those who were free of colorectal localizations of the disease (n = 72). No women were lost to follow-up.
  
  
  METHODS
  The 124 women included in this study were managed for either unilateral or bilateral ovarian endometriomas using plasma energy at a university tertiary care center. Recurrences and pregnancy rate were compared in patients with and without colorectal endometriosis. The minimum length of follow-up was 1 year. Cyst recurrences were assessed using pelvic ultrasound and magnetic resonance imaging. Kaplan-Meier and actuarial life-table analysis were used to estimate the recurrence-free survival curve and the probability of pregnancy. The Cox model was used to assess independent predictive factors for recurrences. Pregnancy likelihood and independent predictors were estimated using a regression logistic model.
  
  
  RESULTS
  Mean follow-up was 32 ± 18 months. Forty-eight patients (40.3%) were presumed infertile and attended an assisted reproductive techniques (ART) center. Eighteen patients presented with a recurrence (14.5%). Bilateral localization of endometriomas was the only factor independently related to an increased risk of recurrences [hazard ratio 3.3, 95% confidence interval (CI) 1.2-9.4]. Of the 83 women wishing to conceive (66.9%), 51 became pregnant (61.4%) and 33 of these pregnancies were spontaneous (64.7%). The rates of pregnancy were 65.8% for the group of patients with associated colorectal endometriosis and 57.8% for controls (P = 0.50). Age over 35 years was the only independent factor for which association with pregnancy rates approached the significance threshold (adjusted odds ratio 0.35, 95% CI 0.12-1, P = 0.06).
  
  
  CONCLUSIONS
  The study sample size may be insufficient to reveal statistically significant differences related to risk factors which have low impact on the probability of recurrence and pregnancy. Data on ovarian reserve before and after the procedure was not available in all patients, which would have added to our results and the discussion about treatment of endometrioma in general.
  
  
  CONCLUSIONS
  Concomitant management of colorectal endometriosis does not impact either risk of recurrences or the probability of pregnancy in women having benefited from ovarian endometrioma ablation using plasma energy. Moreover, surgical management of colorectal and ovarian endometriosis may allow spontaneous conception in one out of three patients, thus reducing expenses related to ART management.
  
  
  BACKGROUND
  No financial support was received for this study. Horace Roman reports personal fees for participating in a symposium and masterclass presenting his experience in the use of PlasmaJet.
authors.affiliation: Department of Gynecology and Obstetrics, Rouen University Hospital, Hospital-Charles Nicolle, 1 rue de Germont, Rouen 76031, France Research Group 4308 'Spermatogenesis and Gamete Quality', IHU Rouen Normandy, IFRMP23, Reproductive Biology Laboratory, Rouen University Hospital, Rouen, France horace.roman@gmail.com.
authors.forename: Horace
authors.initials: H
authors.lastname: Roman
authors.affiliation: Department of Gynecology and Obstetrics, Rouen University Hospital, Hospital-Charles Nicolle, 1 rue de Germont, Rouen 76031, France.
authors.forename: Solène
authors.initials: S
authors.lastname: Quibel
authors.affiliation: Department of Gynecology and Obstetrics, Rouen University Hospital, Hospital-Charles Nicolle, 1 rue de Germont, Rouen 76031, France.
authors.forename: Mathieu
authors.initials: M
authors.lastname: Auber
authors.affiliation: Department of Gynecology and Obstetrics, Rouen University Hospital, Hospital-Charles Nicolle, 1 rue de Germont, Rouen 76031, France.
authors.forename: Hélène
authors.initials: H
authors.lastname: Muszynski
authors.affiliation: Department of Surgery, Rouen University Hospital, Rouen, France.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Huet
authors.affiliation: Department of Gynecology and Obstetrics, Rouen University Hospital, Hospital-Charles Nicolle, 1 rue de Germont, Rouen 76031, France.
authors.forename: Loïc
authors.initials: L
authors.lastname: Marpeau
authors.affiliation: Department of Surgery, Rouen University Hospital, Rouen, France.
authors.forename: Jean Jacques
authors.initials: JJ
authors.lastname: Tuech
mesh_terms: D000328:Adult; D003108:Colonic Diseases / Q000473:pathology / Q000601:surgery; D055356:Endometrial Ablation Techniques / Q000009:adverse effects; D004715:Endometriosis / Q000473:pathology* / Q000601:surgery; D005260:Female; D005298:Fertility; D059247:Fertility Preservation; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D011247:Pregnancy; D018873:Pregnancy Rate; D011446:Prospective Studies; D012002:Rectal Diseases / Q000473:pathology / Q000601:surgery
keywords: ablation; ovarian endometrioma; plasma energy; pregnancy; recurrences