Human Reproduction: From State of the Art to Future Developments “Endometriosis Therapeutic Approaches”

  • Liselotte MettlerEmail author
  • Ibrahim Alkatout
Part of the Reproductive Medicine for Clinicians book series (REMECL, volume 1)


In this evaluation, the first part evaluates three different treatment strategies (hormonal medication, surgical treatment, or combined treatment) and discusses the influence of endometriosis on pregnancy outcome. Four hundred and fifty patients with genital endometriosis, aged 18–44 years, were randomly distributed to three treatment groups at the first laparoscopy. They were reevaluated at a second-look laparoscopy (D 426/10), 1–2 months after the 3-month hormonal therapy for groups 1 and 3 and 5–6 months later for group 2 (surgical treatment alone). Outcome data focused on the recurrence and pregnancy rate.

The three treatment options—independent of the initial endoscopic endometriosis classification (EEC) stage including deep infiltrating endometriosis (DIE)—achieved an overall cure rate of 50% or higher. The highest cure rate of 60% was achieved by the combined treatment, 55% by the exclusive hormonal therapy, and 50% by the exclusive surgical treatment. An overall pregnancy rate between 55 and 65% was achieved with no significant difference in relation to the therapeutical option.

Further we consider in the second part the relation of pregnancy and endometriosis with the following conclusions: (1) increased risk for premature deliveries and pregnancy complications, (2) more frequent preeclampsia and antepartum hemorrhage, (3) increased rate of Cesarean sections, (4) severe pain in pregnancy continues in quite a few patients, and (5) obstetricians should be aware of obstetric emergencies, such as direct bleeding from lesions, bleeding from uterine arteries or veins, interruption of ureter, and severe peritoneal decidualized endometriosis.


Endometriosis Medical and surgical management Pregnancies 


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Copyright information

© IAHR (International Academy of Human Reproduction) 2018

Authors and Affiliations

  1. 1.Department of Obstetrics and GynecologyUniversity Clinics of Schleswig-HolsteinKielGermany

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