Book contents
- 50 Big Debates in Reproductive Medicine
- Series page
- 50 Big Debates in Reproductive Medicine
- Copyright page
- Contents
- Contributors
- Foreword
- Introduction
- Section I Limits for IVF
- Section II IVF Add-ons
- Section III The Best Policy
- 14A IVF Should Be First-Line Treatment for Unexplained Infertility of Two Years Duration
- 14B IVF Should Be First-Line Treatment for Unexplained Infertility of Two Years Duration
- 15A Single Embryo Transfer Should Be Performed in All IVF Cycles
- 15B Single-Embryo Transfer Should Be Performed in All IVF Cycles
- 16A The Freezing of All Embryos Should Be Used for All IVF Cycles
- 16B The Freezing of All Embryos Should Be Used for All IVF Cycles
- 17A Luteal-Phase Support Should Be Stopped at the Time of a Positive Pregnancy Test
- 17B Luteal Phase Support Should Be Stopped at the Time of a Positive Pregnancy Test
- 18A A Natural Cycle Is the Best Protocol for Frozen Embryo Replacement
- 18B A Natural Cycle Is the Best Protocol for Frozen Embryo Replacement
- 19A All Pregnancies Conceived by IVF Should Be Delivered by Caesarean Section
- 19B All Pregnancies Conceived by IVF Should Be Delivered by Caesarean Section
- 20A Endometriosis Should Be Suppressed for 6–12 Weeks before Frozen Embryo Transfer
- 20B Endometriosis Should Be Suppressed for 6–12 Weeks before Frozen Embryo Transfer
- 21A Infertile Patients with Endometriosis Benefit from Surgery
- 21B Infertile Patients with Endometriosis Benefit from Surgery
- 22A Intramural Fibroids Greater than 4 cm in Diameter Should Be Removed to Aid Fertility
- 22B Intramural Fibroids Greater than 4 cm in Diameter Should Be Removed to Aid Fertility
- 23A All Infertile Women with a Uterine Septum Should Have a Surgical Removal
- 23B All Infertile Women with a Uterine Septum Should Have a Surgical Removal
- Section IV Embryology
- Section V Ethics and Statistics
- Section VI Male-factor Infertility
- Section VII Genetics
- Section VIII Ovarian Stimulation
- Section IX Hormones and the Environment
- Index
- References
21B - Infertile Patients with Endometriosis Benefit from Surgery
Against
from Section III - The Best Policy
Published online by Cambridge University Press: 25 November 2021
Book contents
- 50 Big Debates in Reproductive Medicine
- Series page
- 50 Big Debates in Reproductive Medicine
- Copyright page
- Contents
- Contributors
- Foreword
- Introduction
- Section I Limits for IVF
- Section II IVF Add-ons
- Section III The Best Policy
- 14A IVF Should Be First-Line Treatment for Unexplained Infertility of Two Years Duration
- 14B IVF Should Be First-Line Treatment for Unexplained Infertility of Two Years Duration
- 15A Single Embryo Transfer Should Be Performed in All IVF Cycles
- 15B Single-Embryo Transfer Should Be Performed in All IVF Cycles
- 16A The Freezing of All Embryos Should Be Used for All IVF Cycles
- 16B The Freezing of All Embryos Should Be Used for All IVF Cycles
- 17A Luteal-Phase Support Should Be Stopped at the Time of a Positive Pregnancy Test
- 17B Luteal Phase Support Should Be Stopped at the Time of a Positive Pregnancy Test
- 18A A Natural Cycle Is the Best Protocol for Frozen Embryo Replacement
- 18B A Natural Cycle Is the Best Protocol for Frozen Embryo Replacement
- 19A All Pregnancies Conceived by IVF Should Be Delivered by Caesarean Section
- 19B All Pregnancies Conceived by IVF Should Be Delivered by Caesarean Section
- 20A Endometriosis Should Be Suppressed for 6–12 Weeks before Frozen Embryo Transfer
- 20B Endometriosis Should Be Suppressed for 6–12 Weeks before Frozen Embryo Transfer
- 21A Infertile Patients with Endometriosis Benefit from Surgery
- 21B Infertile Patients with Endometriosis Benefit from Surgery
- 22A Intramural Fibroids Greater than 4 cm in Diameter Should Be Removed to Aid Fertility
- 22B Intramural Fibroids Greater than 4 cm in Diameter Should Be Removed to Aid Fertility
- 23A All Infertile Women with a Uterine Septum Should Have a Surgical Removal
- 23B All Infertile Women with a Uterine Septum Should Have a Surgical Removal
- Section IV Embryology
- Section V Ethics and Statistics
- Section VI Male-factor Infertility
- Section VII Genetics
- Section VIII Ovarian Stimulation
- Section IX Hormones and the Environment
- Index
- References
Summary
Operative laparoscopy has been regarded as a viable and evidence-based option for endometriosis-related infertility. However, not all studies support this conclusion and the recent synthesis of high-quality randomised controlled trials (RCTs) in a meta-analysis suggests operative laparoscopy may not be effective at improving fertility-related outcomes when compared to diagnostic laparoscopy (i.e. expectant management) in patients with endometriosis-related infertility. Only one RCT assesses the outcome of live birth rate (LBR) as a primary outcome, which was comparable in both groups (operative (10/51;19.6%) versus diagnostic (10/45;22.2%)) laparoscopy (relative risk (RR) 0.88, 95% confidence interval (CI) 0.40–1.92; very low-quality evidence). Pregnancy rate was assessed as a primary outcome in four RCTs where patients underwent operative (91/316;28.8%) or diagnostic (62/308;20.1%) laparoscopy (RR 1.38, 95%CI 0.99-1.92). Though the evidence is of moderate quality, there is insufficient evidence of a difference between the groups. There are no RCTs comparing operative laparoscopy to assisted reproductive technologies.
- Type
- Chapter
- Information
- 50 Big Debates in Reproductive Medicine , pp. 114 - 116Publisher: Cambridge University PressPrint publication year: 2021
References
Meuleman, C, Vandenabeele, B, Fieuws, S, Spiessens, C, Timmerman, D, D’Hooghe, T. High prevalence of endometriosis in infertile women with normal ovulation and normospermic partners. Fertil Steril. 2009;92:68–74.CrossRefGoogle ScholarPubMed
Duffy, J, Arambage, K, Correa, F, et al. Laparoscopic surgery for endometriosis. Cochrane Database Syst Rev. 2014:79.CrossRefGoogle Scholar
Leonardi, M, Gibbons, T, Armour, M, et al. When to do surgery and when not to do surgery for endometriosis: a systematic review and meta-analysis. J Minim Invasive Gynecol. 2020;27:390–407.e3.CrossRefGoogle Scholar
Lalani, S, Choudhry, AJ, Firth, B, et al. Endometriosis and adverse maternal, fetal and neonatal outcomes, a systematic review and meta-analysis. Hum Reprod. 2018;33:1854–65.CrossRefGoogle ScholarPubMed
Moini, A, Bahar, L, Ashrafinia, M, Eslami, B, Hosseini, R, Ashrafinia, N. Fertility outcome after operative laparoscopy versus no treatment in infertile women with minimal or mild endometriosis. Int J Fertil Steril. 2012;5:235–40.Google ScholarPubMed
Parazzini, F, Fedele, L, Busacca, M, et al. Postsurgical medical treatment of advanced endometriosis: results of a randomized clinical trial. Am J Obstet Gynecol. 1994;171(5):1205–7.CrossRefGoogle ScholarPubMed
Marcoux, S, Maheux, R, Bérubé, S. Laparoscopic surgery in infertile women with minimal or mild endometriosis. Canadian Collaborative Group on Endometriosis. N Eng J Med. 1997;337(4):217–22.CrossRefGoogle ScholarPubMed