Abstract
Analysis of published series reveals that no more than a fourth of subfertile patients
undergoing surgery for peritoneal endometriotic implants, rectovaginal endometriotic
lesions, or recurrent endometriomas achieved conception spontaneously. First-line
surgery for ovarian endometriotic cysts appears associated with a better reproductive
performance, that is, a mean postoperative pregnancy rate of ∼50%. At the same time,
excision of endometriomas paradoxically seems to induce gonadal damage. With the exception
of peritoneal disease, no randomized trials are available to assess the effect of
surgery in subfertile women with endometriosis. Therefore, it is not possible to define
the absolute benefit increase of the treatment of ovarian and rectovaginal lesions.
The decision to undergo surgery for endometriosis-associated subfertility must be
shared with the woman after detailed information and taking into account several additional
conditions, such as presence of pain, large or complex adnexal masses, bowel or ureteral
stenosis, and coexisting infertility factors. When considering surgery, a therapeutic
equipoise should be reached that includes demonstrated benefits, potential morbidity,
and costs of treatment alternatives. Particularly in case of recurrent endometriosis,
in vitro fertilization should generally be preferred to surgery. The role of surgery
in endometriosis-associated subfertility includes temporary pain relief in symptomatic
women desiring a spontaneous conception.
Keywords
endometriosis - infertility - surgery - laparoscopy - ovarian cyst
