Laparoscopic Endometriosis Surgery in Patients with Infertility: Identifying Surgical and Non-Surgical Variables Affecting Postoperative Pregnancy. Long-term Follow-up in a University Endometriosis Center

Abstract

Background

Endometriosis is a disease which affects the quality of life and fertility of many young women. Choosing the right time for surgery is important for the outcome of patients. We evaluated the surgical variables affecting postoperative pregnancy rates.

Method

This study is a retrospective analysis of women treated for endometriosis in Frankfurt University Hospital between 2007 and 2017. A total of 695 patients underwent laparoscopic surgery, of whom 125 patients fulfilled the inclusion criteria of wanting to have a child for more than one year. Finally, 102 patients (82%) with surgery and infertility were followed up for 70 months.

Results

We found a cumulative pregnancy rate of 69.6% after 38 months in our patients. The duration of infertility before surgery had a significant effect on postoperative pregnancy rates. There was no significant difference between the different kinds of surgical techniques, but complete treatment of all visible lesions significantly increased the chance of pregnancy (hazard ratio 2.2). Repeated abdominal operations reduced the chance of postoperative pregnancy and prolonged the time to pregnancy.

Conclusions

In patients with endometriosis and infertility, both laparoscopic surgery with complete resection of all visible lesions and the timing of surgery are important to achieve pregnancy. Early intervention with careful planning of the operation is critical. It is important to avoid repeated operations to achieve the best results regarding pregnancy.

Zusammenfassung

Hintergrund

Endometriose ist eine Krankheit, die sich auf die Lebensqualität und Fertilität vieler junger Frauen auswirkt. Die Wahl des richtigen Zeitpunkts für den chirurgischen Eingriff ist wichtig für das Outcome. Wir haben die chirurgischen Variablen, die sich auf eine postoperative Schwangerschaft auswirken, evaluiert.

Methode

Es handelt sich bei dieser Studie um eine retrospektive Analyse von Patientinnen, die im Universitätskrankenhaus Frankfurt am Main zwischen 2007 und 2017 behandelt wurden. Insgesamt haben sich 695 Patientinnen einer laparoskopischen Operation unterzogen. Das Einschlusskriterium, ein unerfüllter Kinderwunsch seit mehr als einem Jahr, wurde von 125 Patientinnen erfüllt. Schließlich wurden 102 operierten Patientinnen (82%) mit Infertilität über 70 Monate nachbeobachtet.

Ergebnisse

In unserer Patientinnenkohorte betrug die kumulative Schwangerschaftsrate 69,6% nach 38 Monaten. Die Dauer der Infertilität vor dem operativen Eingriff hatte eine signifikante Auswirkung auf eine postoperative Schwangerschaft. Es gab keine signifikanten Unterschiede zwischen den verschiedenen chirurgischen Techniken, aber eine vollständige Resektion aller sichtbaren Endometrioseläsionen hatte eine signifikante Auswirkung auf die Wahrscheinlichkeit einer Schwangerschaft (Risikoquotient 2,2). Wiederholte abdominale Operationen reduzierten die Chance einer postoperativen Schwangerschaft und verlängerten die Zeit bis zum Eintritt einer Schwangerschaft.

Schlussfolgerungen

Bei Patientinnen mit Endometriose und Infertilität sind sowohl ein laparoskopischer Eingriff mit vollständiger Resektion aller sichtbaren Läsionen als auch der Zeitpunkt des Eingriffs wichtig für den Eintritt einer Schwangerschaft. Eine frühe Intervention mit sorgfältiger Planung der Operation ist unerlässlich. Um die besten Ergebnisse für eine Schwangerschaft zu erzielen, ist es wichtig, dass wiederholte chirurgische Eingriffe vermieden werden.

Keywords

endometriosis - infertility - surgical intervention

Schlüsselwörter

Endometriose - Sterilität - chirurgische Intervention

Publication History

Received: 15 July 2024

Accepted after revision: 02 November 2024

Article published online:
02 January 2025

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