Does surgery for deep infiltrating bowel endometriosis improve fertility? A review

Introduction: Reduced fertility is a major concern in women with endometriosis. The influence of surgery of deep infiltrating endometriosis (DIE) affecting the bowel wall on fertility is controversial and the literature on this field is heterogenous. In this review we addressed if surgery for bowel DIE improves spontaneous pregnancy rate and results of in vitro fertilization (IVF), and the potential risk A cc ep te d A rt ic le This article is protected by copyright. All rights reserved. of such surgery. Material and methods: We conducted a literature search including the terms “deep”, “deep infiltrating”, “bowel”, rectovaginal”, “endometriosis”, “fertility”, “infertility” and “IVF” in Pubmed. Results: No randomized controlled studies were found. Other publications of relevance included four retrospective and three prospective observational studies. Moreover, one retrospective study compared results of IVF treatment with or without previous surgery for bowel DIE. All studies included reported detailed data on surgical complications. The poor data quality precluded firm conclusions. The results indicate, however, the possibility that surgery for bowel DIE may improve the spontaneous pregnancy rate, and positive effects on IVF outcome cannot be excluded. Such surgery will be associated with risk of major complications. Conclusion: The lack of proper data preclude conclusions on the potential role for bowel DIE surgery to improve the spontaneous pregnancy rate and results of IVF treatment. Positive effects cannot be excluded, but the definite risk of major complications must be taken into account