Pregnancy outcome following active management of endometriosis after laparoscopy in infertile women – A prospective cohort study

159 Introduction Endometriosis is an important etiological factor in female infertility worldwide. Endometriosis is defined as presence of endometrial glands and stroma outside the uterus mainly in pelvis. The prevalence of endometriosis in infertile women ranges from 25 to 50 % compared to 5 % in fertile women Endometriosis is a disease that deteriorates the reproductive potential of women of child bearing age (Momoeda et al, 2002). Hence methods to improve reproductive outcome carries great significance. Laparoscopy has revolutionized the management of all stages of endometriosis. However with the advent of assisted reproductive techniques, the role of laparoscopic evaluation has come down. This study projects laparoscopy as an accepted and integral part of infertility evaluation. The role of active management after laparoscopy in endometriosis is controversial. The results of COH with CC/gonadotrophins combined with IUI is promising in endometriosis. These treatment options can increase overall fecundity but do not cause regression of endometriotic lesions (Olive DL, 2001). In early stages of endometriosis CC-IUI gives a fecundity rate of 6 to 8% per cycle and with gonadotrophins 12 to 20% per cycle. But randomized controlled trials are lacking in moderate or severe endometriosis. Among the ART, IVF has replaced IUI.Despite high pregnancy rates with IVF, it is expensive and time consuming. Therefore it is reasonable to consider simple and inexpensive therapies such as COH with IUI in conditions like endometriosis.( van Voorhis BJ et al1997). Although conservative surgery at laparoscopy is nowadays considered the treatment of choice for stage 3 and 4 endometriosis. But this approach does not seem to be so effective in preventing the recurrence as well as improving the pregnancy rates (Bussaca et al 2001). The role of GnRH analogues comes here. The aim of GnRH analogues is to accomplish complete resection of lesions that could not be surgically removed, to treat microscopic foci and to increase pregnancy rates. Two studies emphasized the role of short term therapy with GnRH analogues after surgery (Vercellini et al, 1999) while others failed to observe any improvements(Bianchi et al 1999).In the present study we have evaluated the effectiveness of post operative regimen of GnRH analogues for stage 3 and 4 endometriosis. The aim of this study was to assess the prevalence of endometriosis in women attending our centre, reproductive outcome following treatment and predictors for improving outcome.