Background: Endometriosis is the presence of endometrial tissue in extra-uterine areas that can lead to pain and peritoneal adhesions, and may interfere with fertility. Endometriosis and endometrial cysts called endometriomata are common among infertile women (30-50%). For treatment and diagnosis of endometriosis and endometriomata, surgical laparoscopy has become the gold standard. Furthermore, in vitro fertilization (IVF) is another treatment option designed to produce pregnancy. The purpose of this paper was to assess whether surgery alone, in comparison to IVF in combination with surgery, can significantly increase the overall pregnancy rate in patients with endometriosis associated infertility.
Method: An exhaustive search of available medical literature was conducted using Medline through OVID, ISI Web of Science, and CINAHL databases. The following search terms used were endometriosis, infertility, laparoscopy, and in vitro fertilization. Inclusion and exclusion criteria were applied. Strength of evidence was evaluated using the GRADE tool.
Results: Three cohort studies, consisting of one prospective and two retrospective observational studies, were found regarding the use of IVF therapy in combination with surgery versus surgery alone for the treatment of endometriosis associated infertility.
Conclusion: Despite few randomized control trials performed on this topic, the lack of information on risks and costs of treatments, and the overall low GRADE outcome from these observational reports, the overall finding was that IVF therapy in addition to surgery increased the overall fecundity rate in patients with endometriosis associated infertility. More specifically, infertile patients with endometriosis would benefit from the surgical approach as the primary option. Those who do not become pregnant after surgery could pursue an IVF program. Though IVF could be considered a primary treatment option when there are multiple infertility factors or contraindication to surgery. Nevertheless, the combination of surgery and IVF offers the best chance of pregnancy for these patients.
Keywords: endometriosis, infertility, laparoscopy, in vitro fertilization
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