Colorectal endometriosis-associated infertility: should surgery precede ART?

Fertil Steril. 2017 Sep;108(3):525-531.e4. doi: 10.1016/j.fertnstert.2017.07.002. Epub 2017 Aug 12.


Objective: To compare the impact of first-line assisted reproductive technology (ART; intracytoplasmic sperm injection [ICSI]-IVF) and first-line colorectal surgery followed by ART on fertility outcomes in women with colorectal endometriosis-associated infertility.

Design: Retrospective matched cohort study using propensity score (PS) matching (PSM) analysis.

Setting: University referral centers.

Patient(s): A total of 110 women were analyzed from January 2005 to June 2014. A PSM was generated using a logistic regression model based on the age, antimüllerian hormone (AMH) serum level, and presence of adenomyosis to compare the treatment strategy.

Intervention(s): First-line surgery group followed by ART versus exclusive ART with in situ colorectal endometriosis.

Main outcome measure(s): After PSM, pregnancy rates (PRs), live-birth rates (LBRs), and cumulative rates (CRs) were estimated.

Result(s): After PSM, in the whole population, the total LBR and PR were 35.4% (39/110) and 49% (54/110), respectively. The specific cumulative LBR at the first ICSI-IVF cycle in the first-line surgery group compared with the first-line ART was, respectively, 32.7% versus 13.0%; at the second cycle, 58.9% versus 24.8%; and at the third cycle, 70.6% versus 54.9%. The cumulative LBRs were significantly higher for women who underwent first-line surgery followed by ART compared with first-line ART in the subset of women with good prognosis (age ≤ 35 years and AMH ≥ 2 ng/mL and no adenomyosis) and women with AMH serum level < 2 ng/mL.

Conclusion(s): First-line surgery may be a good option for women with colorectal endometriosis-associated infertility.

Keywords: ART; Colorectal endometriosis; infertility; propensity score (PS) matching (PSM); surgery.

MeSH terms

  • Adult
  • Combined Modality Therapy / methods
  • Comorbidity
  • Endometriosis / epidemiology*
  • Endometriosis / surgery*
  • Female
  • France / epidemiology
  • Humans
  • Infertility, Female / diagnosis
  • Infertility, Female / epidemiology*
  • Infertility, Female / therapy*
  • Intestinal Diseases / epidemiology
  • Intestinal Diseases / surgery
  • Pregnancy
  • Pregnancy Outcome / epidemiology*
  • Prevalence
  • Reproductive Techniques, Assisted / statistics & numerical data*
  • Retrospective Studies
  • Risk Factors
  • Treatment Outcome
  • Young Adult