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Deep Infiltrating Endometriosis: a Previous History of Surgery for Endometriosis May Negatively Affect Assisted Reproductive Technology Outcomes

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Abstract

For patients with endometriosis-related infertility, the impact of previous surgery for endometriosis before assisted reproductive technology (ART) remains controversial, particularly in cases of deep infiltrating endometriosis (DE). To study the impact of previous surgery for endometriosis on ART cumulative live-birth rates in DE patients, a retrospective cohort study included 222 DE patients who underwent ART. DE diagnosis was based on strict imaging criteria and histological confirmation of the disease for women with a previous history of surgery for endometriosis. ART outcomes were compared for patients with and without a previous history of surgery for endometriosis. The main outcome measures were cumulative live-birth rates (CLBR). Prognostic factors were identified by comparing women who became pregnant and those who did not, using an adjusted multiple logistic regression model. Two hundred twenty-two DE patients underwent a total of 440 ART cycles (including fresh and associated frozen-thawed embryo transfers). One hundred fifty-five women (69.8%) had a prior history of surgery for endometriosis. The CLBR was 26% after four ART cycles in the “previous history of surgery for endometriosis” group, while it reached 51.3% after four cycles (p < 0.001) in patients who had not previously undergone surgery for endometriosis. After multivariate analysis, a previous history of surgery for endometriosis (p = 0.001) and a past surgery for endometrioma (p = 0.005) were established as independent factors associated with lower pregnancy rates. Our preliminary results suggest that for DE patients, a previous history of surgery for endometriosis may be associated with negative ART outcomes.

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Acknowledgments

The authors thank staff members from our department for their expert assistance with data collection, particularly Valerie Blanchet and Julia Gonnot of the ART unit.

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Author notes

  1. Chloé Maignien and Pietro Santulli contributed equally to this work.

Authors and Affiliations

  1. Department of Gynaecology Obstetrics II and Reproductive Medicine (Professor Chapron), Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, Paris, France

    Chloé Maignien, Pietro Santulli, Mathilde Bourdon, Diane Korb, Louis Marcellin, Marie-Charlotte Lamau & Charles Chapron

  2. Department “Development, Reproduction and Cancer”, Institut Cochin, INSERM U1016 (Professor Batteux), Université Paris Descartes, Sorbonne Paris Cité, Paris, France

    Chloé Maignien, Pietro Santulli, Mathilde Bourdon, Louis Marcellin & Charles Chapron

  3. Department “Development, Reproduction and Cancer”, Institut Cochin, INSERM U1016 (Doctor Vaiman), Université Paris Descartes, Sorbonne Paris Cité, Paris, France

    Charles Chapron

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  1. Chloé Maignien
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Correspondence to Pietro Santulli.

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Chloé Maignien and Pietro Santulli were considered joint first authors.

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Maignien, C., Santulli, P., Bourdon, M. et al. Deep Infiltrating Endometriosis: a Previous History of Surgery for Endometriosis May Negatively Affect Assisted Reproductive Technology Outcomes. Reprod. Sci. 27, 545–554 (2020). https://doi.org/10.1007/s43032-019-00052-1

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