Fertility after laparoscopic management of deep endometriosis infiltratingthe uterosacral ligaments

The aim of this study was to evaluate fertility outcome after laparoscopic management of deep endometriosis infiltrating the uterosacral ligaments (US L). From January 1993 to December 1996, 30 patients who presented with no o ther infertility factors were treated using laparoscopic surgery. The overa ll rate of intrauterine pregnancy (IUP) was 50.0% (15 patients). Only one o f these 15 pregnancies was obtained using in-vitro fertilization techniques (IVF). The cumulative IUP rate for the 14 pregnancies which occurred spont aneously was 48.5% at 12 months (95% confidence interval 28.3-68.7). The ra te of spontaneous pregnancies was not significantly correlated with the rev ised American Fertility Society (rAFS) classification. The rate of IUP was 47.0% (eight cases) for patients with stage I or II endometriosis and 46.1% (six cases) for the patients presenting stage III or IV endometriosis (not significant). These encouraging preliminary results show that in a context of infertility it is reasonable to associate classic treatment for endomet riosis (e.g. lysis, i.p. cystectomy, bipolar coagulation of superficial per itoneal endometriotic lesions) with resection of deep endometriotic lesions infiltrating the USL. Apart from the benefit with respect to the pain symp toms from which these patients suffer, it is possible to use laparoscopic s urgery with substantial retroperitoneal dissection and enable half of the p atients to become pregnant. These results also raise the question of the in fluence of deep endometriotic lesions on infertility.