Sofiane Bendifallah1, Horace Roman2, Emmanuelle Mathieu d'Argent3, Salma Touleimat2, Jonathan Cohen3, Emile Darai4, Marcos Ballester4. 1. Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris, University Pierre and Marie Curie, Institut Universitaire de Cancérologie, Paris, France; INSERM UMRS 707, Epidemiology, Information Systems, Modeling, University Pierre and Marie Curie, Paris, France. Electronic address: sofiane.bendifallah@aphp.fr. 2. Expert Center in the Diagnosis and Multidisciplinary Management of Endometriosis, Department of Gynecology and Obstetrics, Rouen University Hospital, Rouen, France. 3. Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris, University Pierre and Marie Curie, Institut Universitaire de Cancérologie, Paris, France. 4. Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris, University Pierre and Marie Curie, Institut Universitaire de Cancérologie, Paris, France; UMRS 938 Université Pierre et Marie Curie, Paris, France; Groupe de Recherche Clinique GRC6-UPMC, Centre Expert En Endométriose, Paris, France.
Abstract
OBJECTIVE: To compare the impact of first-line assisted reproductive technology (ART; intracytoplasmic sperm injection [ICSI]-IVF) and first-line colorectal surgery followed by ART on fertility outcomes in women with colorectal endometriosis-associated infertility. DESIGN: Retrospective matched cohort study using propensity score (PS) matching (PSM) analysis. SETTING: University referral centers. PATIENT(S): A total of 110 women were analyzed from January 2005 to June 2014. A PSM was generated using a logistic regression model based on the age, antimüllerian hormone (AMH) serum level, and presence of adenomyosis to compare the treatment strategy. INTERVENTION(S): First-line surgery group followed by ART versus exclusive ART with in situ colorectal endometriosis. MAIN OUTCOME MEASURE(S): After PSM, pregnancy rates (PRs), live-birth rates (LBRs), and cumulative rates (CRs) were estimated. RESULT(S): After PSM, in the whole population, the total LBR and PR were 35.4% (39/110) and 49% (54/110), respectively. The specific cumulative LBR at the first ICSI-IVF cycle in the first-line surgery group compared with the first-line ART was, respectively, 32.7% versus 13.0%; at the second cycle, 58.9% versus 24.8%; and at the third cycle, 70.6% versus 54.9%. The cumulative LBRs were significantly higher for women who underwent first-line surgery followed by ART compared with first-line ART in the subset of women with good prognosis (age ≤ 35 years and AMH ≥ 2 ng/mL and no adenomyosis) and women with AMH serum level < 2 ng/mL. CONCLUSION(S): First-line surgery may be a good option for women with colorectal endometriosis-associated infertility.
OBJECTIVE: To compare the impact of first-line assisted reproductive technology (ART; intracytoplasmic sperm injection [ICSI]-IVF) and first-line colorectal surgery followed by ART on fertility outcomes in women with colorectal endometriosis-associated infertility. DESIGN: Retrospective matched cohort study using propensity score (PS) matching (PSM) analysis. SETTING: University referral centers. PATIENT(S): A total of 110 women were analyzed from January 2005 to June 2014. A PSM was generated using a logistic regression model based on the age, antimüllerian hormone (AMH) serum level, and presence of adenomyosis to compare the treatment strategy. INTERVENTION(S): First-line surgery group followed by ART versus exclusive ART with in situ colorectal endometriosis. MAIN OUTCOME MEASURE(S): After PSM, pregnancy rates (PRs), live-birth rates (LBRs), and cumulative rates (CRs) were estimated. RESULT(S): After PSM, in the whole population, the total LBR and PR were 35.4% (39/110) and 49% (54/110), respectively. The specific cumulative LBR at the first ICSI-IVF cycle in the first-line surgery group compared with the first-line ART was, respectively, 32.7% versus 13.0%; at the second cycle, 58.9% versus 24.8%; and at the third cycle, 70.6% versus 54.9%. The cumulative LBRs were significantly higher for women who underwent first-line surgery followed by ART compared with first-line ART in the subset of women with good prognosis (age ≤ 35 years and AMH ≥ 2 ng/mL and no adenomyosis) and women with AMH serum level < 2 ng/mL. CONCLUSION(S): First-line surgery may be a good option for women with colorectal endometriosis-associated infertility.
Authors: S Mittelstadt; A Stäbler; M Kolb; B Krämer; H Horvat; C Reisenauer; C Bachmann Journal: BMC Pregnancy Childbirth Date: 2022-08-17 Impact factor: 3.105