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No Fertility Benefit from Treament of Mild Endometriosis
Title: Reproductive outcome after treatment of mild endometriosis with laparoscopic excision and electrocoagulation
Author: T. Tulandi et al.
Address: Montreal , Quebec
Source: Fertility and Sterility 69: 229-231 (February)1998
Summary: The objective of this study was to compare of pregnancy rates (PR) of 101 infertile women with mild endometriosis, who were treated with either surgical excision (n=53) or electrosurgery(n=48, historical control). The electrocautery group had 24 pregnancies and a PR of 57.1% with 3 (12.5) spontaneous abortions and 1 ectopic pregnancy(4.2%)with a median interval to pregnancy of 10.7 months to conception.
The excision group had 23 pregnancies , PR of 53.5%, 4 spontaneous abortions (17.4%) and 2 ectopic pregnancies(8.7%) with a median interval to pregnancy of 13.3 months to conception. Using the Mantel -Cox test, no statistically significant difference in the probability of conception was found between the two groups. The effects of age and duration of infertility were evaluated using the Cox proportional-hazards model, and were not found to be associated with a decreased PR. The conclusion was drawn that there is no difference in PR of infertile women with mild endometriosis treated laparoscopically by surgical excision or electrocoagulation. It was suggested that a similar evaluation needs to be undertaken between these two modalities for the treatment of endometriosis- related pelvic pain.
Comment: Another contradiction. In 'What's Up Doc' 8/4/97, a an extremely well publicized report of surgical treatment of minimal endometriosis showed a statistically significant effect of surgical therapy on fertility. I believe this previous study had an immediate effect on the practice of medicine, at least in the explanation and hope given to infertile couples. I wish the former study was true. It had contradicted the previously held dogma that treatment of minimal and mild endometriosis did not have an effect on fertility. What do we believe now? Either side of this controversy could be argued theoretically with the same fervor. I know that many patients spontaneously become pregnant after laparoscopy. But then, I always treat endometriosis when found. It is interesting that both treatment and control groups had a fertility rate of over 50% during the subsequent year.
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