Open AccessDoes surgery for deep infiltrating bowel endometriosis improve fertility? A systematic review
Author(s) -
Iversen Maja L.,
SeyerHansen Mikkel,
Forman Axel
Publication year - 2017
Publication title -
acta obstetricia et gynecologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.401
H-Index - 102
eISSN - 1600-0412
pISSN - 0001-6349
DOI - 10.1111/aogs.13152
Subject(s) - medicine , endometriosis , fertility , pregnancy , infertility , pregnancy rate , in vitro fertilisation , retrospective cohort study , observational study , randomized controlled trial , gynecology , obstetrics , surgery , population , environmental health , biology , genetics
Reduced fertility is a major concern in women with endometriosis. The influence of surgery of deep infiltrating endometriosis ( DIE ) affecting the bowel wall on fertility is controversial and the literature on this field is heterogeneous. In this review we addressed whether surgery for bowel DIE improves the spontaneous pregnancy rate, and the results of in vitro fertilization ( IVF ), and the potential risk of such surgery. Material and methods We conducted a literature search including the terms “deep”, “deep infiltrating”, “bowel”, rectovaginal”, “endometriosis”, “fertility”, “infertility” and “ IVF ” in PubMed. Results No randomized controlled studies were found. Other publications of relevance included four retrospective and three prospective observational studies. Moreover, one retrospective study compared results of IVF treatment with or without previous surgery for bowel DIE . All studies reported detailed data on surgical complications. The poor data quality precluded firm conclusions. The results indicate, however, the possibility that surgery for bowel DIE may improve the spontaneous pregnancy rate, and positive effects on IVF outcome cannot be excluded. Such surgery will be associated with risk of major complications. Conclusion The lack of proper data precludes conclusions on the potential role for bowel DIE surgery to improve the spontaneous pregnancy rate and results of IVF treatment. Positive effects cannot be excluded, but the definite risk of major complications must be taken into account.