Colorectal endometriosis and fertility
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- 作者：Emile Daraï ; ; emile.darai@aphp.fr ; Jonathan Cohen ; Marcos Ballester
- 关键词：Endometriosis ; Deep infiltrating endometriosis ; Colorectal endometriosis ; Surgery ; fertility ; Medically assisted reproduction ; Assisted reproductive therapy
- 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：86-94
- 全文大小：705 K
- 卷排序：209
文摘
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.Study designMEDLINE 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”.ResultsSpontaneous 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).ConclusionOur 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.