Surgery for endometriosis can improve fertility

Women with endometriosis that involves the bowel find their chances of becoming pregnant go up substantially after they undergo “keyhole” surgery to remove the affected section of bowel, a new report indicates.

Endometriosis occurs when tissue that normally lines the womb also grows at other sites within the abdomen, which may include the surface of the digestive tract. This can cause severe pain and infertility problems.

Previous reports have shown standard surgery markedly enhances fertility in women with so-called colorectal endometriosis, and recently it has been shown that performing the procedure under laparoscopy is feasible. However, little was known about the effect of this minimally invasive approach on fertility.

To investigate, Dr. Emile Darai, from Hopital Tenon in Paris, and colleagues assessed the fertility outcomes of 22 endometriosis patients who underwent laparoscopic colorectal resection and wanted to conceive. The average follow-up period after surgery was 24 months.

Ten of the women (45 percent) became pregnant after an average of 8 months, the researchers report in the medical journal Fertility and Sterility.

Infertility is the inability to achieve a pregnancy after 12 months of unprotected intercourse.

Causes, incidence, and risk factors
Primary infertility is the term used to describe a couple that has never been able to conceive a pregnancy, after at least 1 year of unprotected intercourse. The term secondary infertility describes couples who have previously been pregnant at least once, but have not been able to achieve another pregnancy.

Causes of infertility include a wide range of physical as well as emotional factors. Approximately 30% to 40% of all infertility is due to a “male” factor, such as retrograde ejaculation, impotence, hormone deficiency, environmental pollutants, scarring from sexually transmitted disease, or decreased sperm count. Some factors affecting sperm count are heavy marijuana use or use of prescription drugs such as cimetidine, spironolactone, and nitrofurantoin.

A total of 12 pregnancies occurred - nine through spontaneous conception and three after in vitro fertilization.

The nine spontaneous pregnancies included seven delivered vaginally, one delivered by c-section, and one ongoing pregnancy. The IVF pregnancies included one Miscarriage, one ongoing twin pregnancy, and one triplet pregnancy that resulted in two surviving infants.

Endometriosis is a condition in which the endometrium, tissue that normally lines the uterus, grows in other areas of the body, causing pain, irregular bleeding, and frequently infertility.

The tissue growth typically occurs in the pelvic area, outside of the uterus, on the ovaries, bowel, rectum, bladder, and the delicate lining of the pelvis, but it can occur in other areas of the body as well.

Causes, incidence, and risk factors
The cause of endometriosis is unknown. However, a number of theories have been proposed. The retrograde-menstruation theory proposes that endometrial cells (loosened during menstruation) may “back up” through the fallopian tubes into the pelvis, where they implant and grow in the pelvic and/or abdominal cavities.

The immune-system theory suggests that a deficiency in the immune system allows menstrual tissue to implant and grow in areas other than the uterine lining. Another theory suggests that the cells lining the abdominal cavity may spontaneously develop endometriosis. A genetic theory proposes that certain families may exhibit predisposing factors that lead to endometriosis.

Therefore, the live birth rate was 82 percent.

These preliminary results after laparoscopic removal of a segment of the colon for endometriosis “tend to confirm that extensive surgery can enhance fertility,” the team writes. Further trials are required to identify “the patient population most likely to benefit from this major surgery.”

SOURCE: Fertility and Sterility, October 2005.

Provided by ArmMed Media
Revision date: June 11, 2011
Last revised: by Jorge P. Ribeiro, MD