Ablation of lesions or no treatment in minimal-mild endometriosis in infertile women: a randomized trial

In order to analyse the efficacy of resection/ablation of mininal/mild endo metriotic lesions for improving fertility, we conducted a randomized clinic al trial. Eligible patients were women aged less than or equal to 36 years who were trying to conceive and had a laparoscopically confirmed diagnosis of minimal/mild endometriosis (stage I or II of the revised American Fertil ity Society classification) and otherwise unexplained infertility for great er than or equal to 2 years. Eligible women were randomly assigned to resec tion Or ablation of visible endometriosis (54 patients) or diagnostic lapar oscopy only (47 patients). After laparoscopy women tried to conceive sponta neously for 1 year (follow-up period). A total of five women withdrew from the study: three for personal reasons, and two were lost to follow-up. Cons idering 51 women in the resection/ablation and 45 in the no-treatment group who ended the follow-up period, 12 (24%) in the resection/ablation group a nd 13 (29%) in the no treatment group conceived; the difference was not sig nificant. Two spontaneous abortions were observed in the resection/ablation group and three in the no-treatment one. Thus the 1 year birth rate was 10 out of 51 women (19.6%) in the resection/ablation group and 10 out of 45 w omen (22.2%) in the no-treatment group. In conclusion, the results of this study do not support the hypothesis that ablation of endometriotic lesions markedly improves fertility rates.