To evaluate the predictors of spontaneous pregnancy and to define factors that can improve the reproductive potential of patients with endometriosis-associated infertility.
Material and methods
We studied 154 patients with infertility caused by external genital endometriosis, who underwent laparoscopic surgery. After surgery, 56 patients were treated with dienogest to reduce the level of estrogen (n=8), dydrogesterone to correct luteal phase deficiency (n=56) and low-molecular-weight heparins in order to improve uterine blood flow (n=15).
Sixty patients have become pregnant within one year after surgery. The chance of spontaneous pregnancy was higher in patients younger than 32 years (odds ratio [ОR] 3.27, 95% confidence interval [CI] 1.63-6.54) and with duration of infertility less than 3 years (ОR 1.99, 95% CI 1.02-3.89) and lower in patients with bilateral ovarian endometriomas (ОR 0.30, 95% CI 0.09-0.94). The chance of pregnancy did not depend on the stage of endometriosis (1-2 stage vs. 3-4 stage: ОR 1.07, 95% CI 0.53-2.13). The extent of surgery was similar in patients who have got and have not got pregnant. Drug therapy after surgery was associated with an increased probability of pregnancy (ОR 2.61, 95% CI 1.33-5.15). A combination of gestagens and low-molecular-weight heparins seemed to be the most effective regimen of treatment.
Laparoscopic removal of endometrioid heterotopies is an effective treatment of endometriosis-associated infertility in patients of reproductive age. The significant predictors of spontaneous pregnancy after surgery were age <32 years, duration of infertility <3 years, the absence of bilateral ovarian endometriomas, and drug therapy aimed at adaptation of the vascular system of the uterus for pregnancy.
Endometriosis, infertility, pregnancy.