title: [Surgery for deep infiltrating endometriosis before in vitro fertilization: no benefit for fertility?].
abstract: OBJECTIVE
  Does surgery for deep infiltrating endometriosis (DIE) before in vitro fertilization (IVF) improve pregnancy and birth rate?
  
  
  METHODS
  Cohort study of 177 consecutive patients with DIE related infertility and receiving IVF. Patients were divided into 3 groups according to surgical management decided during multidisciplinary team meeting. Group no surgery (NS) (n=65), group complete surgery (CS) with complete resection of all lesions (n=49) and group incomplete surgery (IS) with gestures improving ovaries accessibility for IVF and/or facilitating embryonic implantation (n=63). Pre-surgery clinical, MRI lesion locations, and history of IVF characteristics were analyzed with logistic regression.
  
  
  RESULTS
  There was no significant difference in general and IVF characteristics and in the severity of endometriosis among the three groups (P=0.43). Overall pregnancy and birth rates after IVF were 45.8% and 33.3%, respectively and were not different among the 3 groups (P=0.59 and P=0.49). Four major complications during oocytes retrievals were observed in NS group, one in IS group and none in CS group. Presence of an inter-utero-rectal lesion at MRI decreased the rate of pregnancy (OR=0.49 [0.25, 0.97]).
  
  
  CONCLUSIONS
  Surgery for deep infiltrating endometriosis does not improve pregnancy and birth rates before IVF. This inter-utero-rectal extensive lesion might explain IVF failures by ovarian difficult access and difficulties in embryonic transfers. Further studies should explore the impact of surgical excision of inter-utero-rectal lesion on oocyte retrieval and embryonic transfer.
authors.affiliation: Service de gynécologie endocrinienne et de médecine de la reproduction, hôpital Jeanne-de-Flandre, université Lille Nord de France, 59000 Lille, France. Electronic address: anne.capelle5@gmail.com.
authors.forename: A
authors.initials: A
authors.lastname: Capelle
authors.affiliation: Service de gynécologie endocrinienne et de médecine de la reproduction, hôpital Jeanne-de-Flandre, université Lille Nord de France, 59000 Lille, France; Service de chirurgie gynécologique, hôpital Jeanne-de-Flandre, université Lille Nord de France, 59000 Lille, France.
authors.forename: J
authors.initials: J
authors.lastname: Lepage
authors.affiliation: Service de biostatistique, pôle de santé publique, université Lille Nord de France, 59000 Lille, France.
authors.forename: C
authors.initials: C
authors.lastname: Langlois
authors.affiliation: Service de gynécologie endocrinienne et de médecine de la reproduction, hôpital Jeanne-de-Flandre, université Lille Nord de France, 59000 Lille, France.
authors.forename: C
authors.initials: C
authors.lastname: Lefebvre
authors.affiliation: Service de gynécologie endocrinienne et de médecine de la reproduction, hôpital Jeanne-de-Flandre, université Lille Nord de France, 59000 Lille, France.
authors.forename: D
authors.initials: D
authors.lastname: Dewailly
authors.affiliation: Service de chirurgie gynécologique, hôpital Jeanne-de-Flandre, université Lille Nord de France, 59000 Lille, France.
authors.forename: P
authors.initials: P
authors.lastname: Collinet
authors.affiliation: Service de chirurgie gynécologique, hôpital Jeanne-de-Flandre, université Lille Nord de France, 59000 Lille, France.
authors.forename: C
authors.initials: C
authors.lastname: Rubod
mesh_terms: D000328:Adult; D001723:Birth Rate; D015331:Cohort Studies; D004715:Endometriosis / Q000473:pathology / Q000601:surgery*; D005260:Female; D005307:Fertilization in Vitro; D006801:Humans; D007247:Infertility, Female / Q000628:therapy; D011247:Pregnancy; D018873:Pregnancy Rate
keywords: Chirurgie; Endometriosis; Endométriose; Fécondation in vitro; In vitro fertilization; Infertility; Infertilité; Inter-utero-rectal lesion; Lésion inter-utéro-rectale; Surgery