Prior colorectal surgery for endometriosis-associated infertility improves ICSI-IVF outcomes: results from two expert centres

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• 作者：Marcos Ballester^a ; ^b ; ^c ; ¹ ; ^{marcos.ballester@tnn.aphp.fr} ; Horace Roman^d ; ¹ ; Emmanuelle Mathieu^a ; ^b ; Salma Touleimat^d ; Jeremy Belghiti^a ; ^b ; Emile Daraï ; ^a ; ^b ; ^c
• 关键词：Infertility ; Colorectal endometriosis ; ICSI-IVF ; Pregnancy rate ; Cumulative pregnancy rate
• 刊名：European Journal of Obstetrics & Gynecology and Reproductive Biology
• 出版年：2017
• 出版时间：February 2017
• 年：2017
• 卷：209
• 期：Complete
• 页码：95-99
• 全文大小：494 K
• 卷排序：209

文摘

To assess fertility outcomes after ICSI-IVF in infertile women having undergone prior complete surgical removal of colorectal endometriosis.Study designProspective 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.ResultsThe 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.Conclusion(s)Colorectal surgery for endometriosis completed by ICSI-IVF is a good option for women with proven infertility, even if prior ICSI-IVF had failed.