title: Colorectal endometriosis and fertility.
abstract: OBJECTIVE
  The goal of this review was to assess the impact of colorectal endometriosis on spontaneous fertility and the potential benefit of Medically Assisted Reproduction (MAR) (in vitro fertilization and intrauterine insemination) and surgery on fertility outcomes.
  
  
  METHODS
  MEDLINE search for articles on fertility in women with DIE published between 1990 and December 2015 using the following terms: "deep endometriosis", "deep infiltrating endometriosis", "bowel endometriosis", "colorectal endometriosis", "fertility", "infertility", "IVF-ICSI", "Assisted Reproductive Techniques (ART)", and "MAR".
  
  
  RESULTS
  Spontaneous pregnancy rate (PR) in patients undergoing resection of DIE but leaving in situ colorectal endometriosis was 26.5% (95% CI=14-39). PR after MAR was 27.4% (95% CI=19-35) and the overall PR was 37.9% (95% CI=29-37). After colorectal surgery, among the 855 patients with and without proved infertility, the spontaneous PR was 31.4% (95% CI=28-34) without difference between the groups. PR after MAR was 19.8% (95% CI=17-22). PR after MAR in patients with and without proved infertility was 21.4% (95% CI=18-25) and 15.5% (95% CI=11-20), respectively. The overall PR after colorectal surgery was 51.1% (95% CI=48-54).
  
  
  CONCLUSIONS
  Our review supports a potential benefit of surgery on fertility outcomes for women with colorectal endometriosis. Further studies are required to determine whether surgical management should be first-intention or restricted to failure of MAR.
authors.affiliation: Department of Gynecology and Obstetrics, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris, UMRS-938, Université Pierre et Marie Curie Paris 6, Groupe de Recherche Clinique (GRC 6-UPMC), Centre Expert en Endométriose (C3E), France. Electronic address: emile.darai@aphp.fr.
authors.forename: Emile
authors.initials: E
authors.lastname: Daraï
authors.affiliation: Department of Gynecology and Obstetrics, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris, UMRS-938, Université Pierre et Marie Curie Paris 6, Groupe de Recherche Clinique (GRC 6-UPMC), Centre Expert en Endométriose (C3E), France.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Cohen
authors.affiliation: Department of Gynecology and Obstetrics, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris, UMRS-938, Université Pierre et Marie Curie Paris 6, Groupe de Recherche Clinique (GRC 6-UPMC), Centre Expert en Endométriose (C3E), France.
authors.forename: Marcos
authors.initials: M
authors.lastname: Ballester
mesh_terms: 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; D027724:Reproductive Techniques, Assisted; D016896:Treatment Outcome
keywords: Assisted reproductive therapy; Colorectal endometriosis; Deep infiltrating endometriosis; Endometriosis; Medically assisted reproduction; Surgery; fertility