title: Prior colorectal surgery for endometriosis-associated infertility improves ICSI-IVF outcomes: results from two expert centres.
abstract: OBJECTIVE
  To assess fertility outcomes after ICSI-IVF in infertile women having undergone prior complete surgical removal of colorectal endometriosis.
  
  
  METHODS
  Prospective longitudinal cohort study in two referral French centres including 60 infertile women who underwent ICSI-IVF after complete surgical removal of colorectal endometriosis, from January 2005 to May 2014. Women underwent either conservative colorectal surgery (i.e., rectal shaving or full thickness disc excision, n=18) or segmental colorectal resection (n=42). Clinical pregnancies were defined by the presence of a gestational sac on vaginal ultrasound examination from the fifth week. The overall pregnancy rate was calculated. The Kaplan-Meier method was used to estimate the cumulative pregnancy rate (CPR). Comparisons of CPR were made using the log-rank test to detect determinant factors.
  
  
  RESULTS
  The median number of ICSI-IVF cycles per patient was one (range: 1-4). Of the 60 women, 36 became pregnant (i.e., overall pregnancy rate=60%). The CPR was 41.7% after one ICSI-IVF cycle, 65% after two ICSI-IVF cycles and 78.1% after three ICSI-IVF cycles. A decreased CPR was observed for women who required segmental colorectal resection compared to those who underwent rectal shaving or full thickness disc excision (p=0.04). A trend for a decreased CPR was observed for women who received a first ICSI-IVF cycle more than 18 months following surgery (p=0.07). Among the nine women with prior ICSI-IVF failure, five (55.5%) became pregnant after surgery.
  
  
  CONCLUSIONS
  Colorectal surgery for endometriosis completed by ICSI-IVF is a good option for women with proven infertility, even if prior ICSI-IVF had failed.
authors.affiliation: Department of Obstetrics and Gynecology, Tenon University Hospital, Assistance Publique Hôpitaux de Paris, Paris, France; GRC-6 UPMC: Centre Expert en Endométriose (C3E), Université Pierre et Marie Curie, Paris, France; Unité INSERM UMR_S 938, Université Pierre et Marie Curie, Paris, France. Electronic address: marcos.ballester@tnn.aphp.fr.
authors.forename: Marcos
authors.initials: M
authors.lastname: Ballester
authors.affiliation: Department of Obstetrics and Gynecology, Rouen University Hospital, Rouen, France.
authors.forename: Horace
authors.initials: H
authors.lastname: Roman
authors.affiliation: Department of Obstetrics and Gynecology, Tenon University Hospital, Assistance Publique Hôpitaux de Paris, Paris, France; GRC-6 UPMC: Centre Expert en Endométriose (C3E), Université Pierre et Marie Curie, Paris, France.
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Mathieu
authors.affiliation: Department of Obstetrics and Gynecology, Rouen University Hospital, Rouen, France.
authors.forename: Salma
authors.initials: S
authors.lastname: Touleimat
authors.affiliation: Department of Obstetrics and Gynecology, Tenon University Hospital, Assistance Publique Hôpitaux de Paris, Paris, France; GRC-6 UPMC: Centre Expert en Endométriose (C3E), Université Pierre et Marie Curie, Paris, France.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Belghiti
authors.affiliation: Department of Obstetrics and Gynecology, Tenon University Hospital, Assistance Publique Hôpitaux de Paris, Paris, France; GRC-6 UPMC: Centre Expert en Endométriose (C3E), Université Pierre et Marie Curie, Paris, France; Unité INSERM UMR_S 938, Université Pierre et Marie Curie, Paris, France.
authors.forename: Emile
authors.initials: E
authors.lastname: Daraï
mesh_terms: D000328:Adult; D013505:Digestive System Surgical Procedures / Q000379:methods*; D004715:Endometriosis / Q000150:complications / Q000601:surgery*; D005260:Female; D005307:Fertilization in Vitro; D006801:Humans; D007247:Infertility, Female / Q000209:etiology / Q000601:surgery*; D007410:Intestinal Diseases / Q000150:complications / Q000601:surgery*; D011247:Pregnancy; D018873:Pregnancy Rate; D011446:Prospective Studies; D020554:Sperm Injections, Intracytoplasmic; D016896:Treatment Outcome
keywords: Colorectal endometriosis; Cumulative pregnancy rate; ICSI-IVF; Infertility; Pregnancy rate