Laparoscopic Endometriosis Surgery in Patients with Infertility: Identifying Surgical and Non-Surgical Variables Affecting Postoperative Pregnancy. Long-term Follow-up in a University Endometriosis Center.

Background: Endometriosis is a disease which affects the quality of life and fertility of many young women. Choosing the right time for surgery is important for the outcome of patients. We evaluated the surgical variables affecting postoperative pregnancy rates.

Method: This study is a retrospective analysis of women treated for endometriosis in Frankfurt University Hospital between 2007 and 2017. A total of 695 patients underwent laparoscopic surgery, of whom 125 patients fulfilled the inclusion criteria of wanting to have a child for more than one year. Finally, 102 patients (82%) with surgery and infertility were followed up for 70 months.

Results: We found a cumulative pregnancy rate of 69.6% after 38 months in our patients. The duration of infertility before surgery had a significant effect on postoperative pregnancy rates. There was no significant difference between the different kinds of surgical techniques, but complete treatment of all visible lesions significantly increased the chance of pregnancy (hazard ratio 2.2). Repeated abdominal operations reduced the chance of postoperative pregnancy and prolonged the time to pregnancy.

Conclusions: In patients with endometriosis and infertility, both laparoscopic surgery with complete resection of all visible lesions and the timing of surgery are important to achieve pregnancy. Early intervention with careful planning of the operation is critical. It is important to avoid repeated operations to achieve the best results regarding pregnancy.