Factors affecting postoperative pregnancy rate after endoscopic managementof large endometriomata

Objective: To identify factors influencing postoperative pregnancy rate in women with extensive endometriosis and large endometriomata as the only ide ntified cause of infertility that were treated by laparoscopy. Method: Sixt y-four infertile patients with endometriomata (greater than or equal to 3 c m) and no other apparent cause of infertility. The latter were removed by o perative laparoscopy. Life table calculations, the Student's t-test and the chi(2) test were used where appropriate. Result: Thirty-four patients (53% ) became pregnant during the 2-year follow-up period. A significantly incre ased pregnancy rate was found for the first year compared to the second (76 vs. 24%). The existence of adhesions affected adversely the outcome of the operation only as far as early achievement of pregnancy is considered. The number and size of endometriomata and the existence of peritoneal implants have not been found to affect pregnancy rates. The severity of the disease did not affect pregnancy rate, but in the cases with moderate disease most of the pregnancies were achieved during the first postoperative year. The duration of infertility was significantly associated only at the 10% level with decreased pregnancy rates. Conclusion: Extensive endometriosis with la rge endometriomata can be safely and effectively treated with laparoscopy u sing the traditional laparoscopic tools providing the infertile patient wit h a high chance to conceive in a relatively short period of time postoperat ively. (C) 1998 International Federation of Gynecology and Obstetrics.