title: Fertility outcome of laparoscopic treatment in patients with severe endometriosis and repeated in vitro fertilization failures.
abstract: OBJECTIVE
  To evaluate fertility outcomes in infertile women with severe endometriosis (The revised American Fertility Society classification [AFS] 3-4) and repeated IVF failures, who underwent surgery due to exacerbation of endometriosis-related symptoms.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  University hospital.
  
  
  METHODS
  All women who failed IVF treatment before surgery and who underwent laparoscopic surgery for severe endometriosis between January 2006 and December 2014.
  
  
  METHODS
  All patients were operated by highly skilled surgeons specializing in laparoscopic surgery for advanced endometriosis. Only patients with evidence of endometriosis in the pathology specimens were included in this study.
  
  
  METHODS
  Delivery rate after surgery.
  
  
  RESULTS
  Seventy-eight women were included in the present study. All women were diagnosed with severe endometriosis during surgery (AFS 3-4) and all women had experienced failed IVF treatments before surgery. All women were symptomatic before their surgery. After surgical treatment 33 women (42.3%) delivered. Three women (9%) conceived spontaneously and all other women conceived after IVF treatment. Women who delivered were younger (32.5 [±4.1] years vs. 35.5 [±3.8] years), were less often diagnosed with diminished ovarian reserve before surgery (6% vs. 28.8%), and were more often diagnosed with normal uterine anatomy (by preoperative transvaginal ultrasound and during operation). In addition, performing salpingectomy during surgery was associated with a trend of improvement in delivery rates after surgery (70% in women who delivered vs. 51% in women who failed to deliver).
  
  
  CONCLUSIONS
  Symptomatic women with severe endometriosis and repeated IVF implantation failures may benefit from extensive laparoscopic surgery when performed by an experienced multidisciplinary surgical team to improve IVF outcome.
authors.affiliation: Department of Obstetrics and Gynecology, Sheba Medical Center Tel Hashomer, Ramat Gan, Israel; Endometriosis Center, Sheba Medical Center Tel Hashomer, Ramat Gan, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. Electronic address: didisoriano@gmail.com.
authors.forename: David
authors.initials: D
authors.lastname: Soriano
authors.affiliation: Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Iris
authors.initials: I
authors.lastname: Adler
authors.affiliation: Department of Obstetrics and Gynecology, Sheba Medical Center Tel Hashomer, Ramat Gan, Israel; Endometriosis Center, Sheba Medical Center Tel Hashomer, Ramat Gan, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Jerome
authors.initials: J
authors.lastname: Bouaziz
authors.affiliation: Department of Obstetrics and Gynecology, Sheba Medical Center Tel Hashomer, Ramat Gan, Israel; Endometriosis Center, Sheba Medical Center Tel Hashomer, Ramat Gan, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Matti
authors.initials: M
authors.lastname: Zolti
authors.affiliation: Department of Obstetrics and Gynecology, Sheba Medical Center Tel Hashomer, Ramat Gan, Israel; Endometriosis Center, Sheba Medical Center Tel Hashomer, Ramat Gan, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Vered H
authors.initials: VH
authors.lastname: Eisenberg
authors.affiliation: Department of Obstetrics and Gynecology, Sheba Medical Center Tel Hashomer, Ramat Gan, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Mordechai
authors.initials: M
authors.lastname: Goldenberg
authors.affiliation: Department of Obstetrics and Gynecology, Sheba Medical Center Tel Hashomer, Ramat Gan, Israel; IVF Unit, Sheba Medical Center Tel Hashomer, Ramat Gan, Israel; IVF Unit, Assuta Medical Center, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Seidman
authors.affiliation: Department of Obstetrics and Gynecology, Sheba Medical Center Tel Hashomer, Ramat Gan, Israel; IVF Unit, Sheba Medical Center Tel Hashomer, Ramat Gan, Israel; IVF Unit, Assuta Medical Center, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Shai E
authors.initials: SE
authors.lastname: Elizur
mesh_terms: D000328:Adult; D004715:Endometriosis / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005298:Fertility; D005307:Fertilization in Vitro / Q000009:adverse effects*; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D006785:Hospitals, University; D006801:Humans; D007247:Infertility, Female / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D010535:Laparoscopy / Q000009:adverse effects; D050498:Live Birth; D008423:Maternal Age; D065851:Ovarian Reserve; D011247:Pregnancy; D018873:Pregnancy Rate; D019233:Retreatment; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D017211:Treatment Failure
keywords: Endometriosis; IVF failure; fertility; radical surgery