title: Impact of Laparoscopic Surgical Management of Deep Endometriosis on Pregnancy Rate.
abstract: OBJECTIVE
  To evaluate the impact of laparoscopic excision of lesions on deep endometriosis-related infertility.
  
  
  METHODS
  Retrospective study.
  
  
  METHODS
  Endometriosis tertiary referral center (Canadian Task Force II-2).
  
  
  METHODS
  A group of 115 patients who had undergone laparoscopic surgery for infertility with histologic confirmation of deep endometriosis.
  
  
  METHODS
  Patient medical records and operative reports were reviewed. Telephone interviews were conducted for long-term follow-up of fertility outcomes.
  
  
  RESULTS
  Evaluation of fertility outcome after laparoscopic treatment of deep endometriosis by spontaneous conception and by assisted reproductive technology (ART) correlated with lesion number, size, and location (anterior, posterolateral, pouch of Douglas, and multiple locations). After a mean follow-up of 22 months the overall pregnancy rate was 54.78% (n = 63) with a live-birth rate of 42.6% (n = 49). Among those patients given the chance to conceive spontaneously (n = 70), the overall pregnancy rate was 60% (n = 42): 38.5% (n = 27) spontaneously and 21.4% (n = 15) by ART. The removal of multiple lesions was associated with a higher pregnancy rate after surgery. When comparing isolated lesion size and disease location, there was no difference in pregnancy rate. Furthermore, those patients who underwent surgical eradication of the disease for the first time had a higher pregnancy rate (odds ratio, 4.18).
  
  
  CONCLUSIONS
  This study demonstrates that laparoscopic excision of deep endometriosis enhances pregnancy rate, by both spontaneous conception and ART. First surgical treatment of multiple lesions was associated with higher pregnancy rates, whereas isolated lesions influenced the pregnancy rate irrespective of their location and size.
authors.affiliation: IRCAD, Hopitaux Universitaires, Strasbourg, France; Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Centini
authors.affiliation: IRCAD, Hopitaux Universitaires, Strasbourg, France.
authors.forename: Karolina
authors.initials: K
authors.lastname: Afors
authors.affiliation: IRCAD, Hopitaux Universitaires, Strasbourg, France.
authors.forename: Rouba
authors.initials: R
authors.lastname: Murtada
authors.affiliation: IRCAD, Hopitaux Universitaires, Strasbourg, France.
authors.forename: István Máté
authors.initials: IM
authors.lastname: Argay
authors.affiliation: Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy.
authors.forename: Lucia
authors.initials: L
authors.lastname: Lazzeri
authors.affiliation: CHRU de Strasbourg, Pôle de Gynécologie-Obstétrique, Hôpital de Hautepierre, Strasbourg, France.
authors.forename: Cherif Youssef
authors.initials: CY
authors.lastname: Akladios
authors.affiliation: Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy. Electronic address: ezupi@libero.it.
authors.forename: Errico
authors.initials: E
authors.lastname: Zupi
authors.affiliation: Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy.
authors.forename: Felice
authors.initials: F
authors.lastname: Petraglia
authors.affiliation: IRCAD, Hopitaux Universitaires, Strasbourg, France.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Wattiez
mesh_terms: D000328:Adult; D004715:Endometriosis / Q000150:complications / Q000601:surgery*; D005260:Female; D006801:Humans; D007247:Infertility, Female / Q000209:etiology / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D011247:Pregnancy; D018873:Pregnancy Rate; D027724:Reproductive Techniques, Assisted; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Deep endometriosis; Infertility; Laparoscopic treatment; Lesion localization; Pregnancy rate