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LAPAROSCOPIC SURGERY FOR INFERTILE WOMEN WITH MILD ENDOMETRIOSIS.

It is unclear whether surgical treatment for mild endometriosis improves fertility. To address this question, Canadian researchers conducted a multicenter, randomized trial involving 341 ovulating women who had attempted to become pregnant for at least one year without success. All had minimal-to-mild endometriosis diagnosed laparoscopically. Those with severe adhesions were excluded.

At diagnostic laparoscopy, half the women received no treatment for endometriosis or adhesions, and the other half underwent resection or ablation of visible endometriosis lesions; adhesions were lysed in 14 percent of this group. The endpoint was pregnancy within 36 weeks; pregnancies were followed for 20 additional weeks.

Patients who had surgical treatment were significantly more likely to have a viable pregnancy than those who had diagnostic laparoscopy only (31 vs. 18 percent). A subgroup of 284 women with no adhesions had a similar relative benefit from surgery.

Comment: The absolute difference of 13 percent suggests that about one of eight women with minimal-to-mild endometriosis would benefit from laparoscopic surgery, at least during a nine-month follow-up. An editorialist implies that it now might be worthwhile to compare laparoscopic surgery with empirical medical therapy for endometriosis.

— AS Brett

Published in Journal Watch General Medicine July 25, 1997

Citation(s):

Marcoux S et al. Laparoscopic surgery in infertile women with minimal or mild endometriosis. N Engl J Med 1997 Jul 24 337 217-222.

• Medline abstract (Free)

Gambone JC and DeCherney AH. Surgical treatment of minimal endometriosis. N Engl J Med 1997 Jul 24 337 269-270.

• Medline abstract (Free)

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