Medline ® Abstract for Reference 47
of 'Endometriosis: Treatment of rectovaginal and bowel disease'
Reproductive performance in infertile women with rectovaginal endometriosis: is surgery worthwhile?
Vercellini P, Pietropaolo G, De Giorgi O, Daguati R, Pasin R, Crosignani PG
Am J Obstet Gynecol. 2006;195(5):1303.
OBJECTIVE: This study was undertaken to ascertain whether the incidence of pregnancy is increased and time-to-conception is reduced in infertile women with rectovaginal endometriosis undergoing conservative surgery compared with those on expectant management.
STUDY DESIGN: A total of 105 infertile women under the age of 40 years with rectovaginal endometriosis and no other associated major infertility factor underwent first-line conservative surgery at laparotomy or expectant management according to a shared decision-making approach.
RESULTS: Among the 44 women who had resection of rectovaginal endometriosis, 15 became pregnant, compared with 22 of the 61 women who choose expectant management (24-month cumulative probabilities, 44.9% and 46.8%, respectively; log-rank test, chi2(1) = 0.75; P = .38). One major and 9 minor postoperative complications occurred. Significant differences in pain-free survival time in favor of the surgery group were observed for dysmenorrhea, dyspareunia, and dyschezia.
CONCLUSION: Conservative surgery for rectovaginal endometriosis in infertile women does not modify the reproductive prognosis although it does increase pain-free survival time.
Benign Gynecologic Surgery Unit, Clinica Ostetrica e Ginecologica II, University of Milan, Istituto Luigi Mangiagalli, Milan, Italy.