Publication:

Reproductive outcome after laparoscopy for stage I and stage II endometriosis

Background Endometriosis is a chronic and recurrent disease commonly afflicting women of reproductive age, contributing to 30-50% cases of infertility. 30% cumulative probability of achieving pregnancy is reported following surgical management of minimal and mild endometriosis.

Methods Prospective observational study was conducted at Apollo Women’s hospital, Chennai between July 2020 and June 2021. 82 eligible women who satisfied the study criteria took part in it. During surgery, diagnosis of Stage I (Minimal endometriosis, few superficial implants, score 1-5) or Stage II endometriosis (Mild endometriosis, more deeper implants, score 6-15) made and lesions excised completely. Patients followed up for 6 months for outcome. Time taken, mode of conception and improvement in pain score were documented. Collected data was analysed.

Results 41.5% had successful pregnancy outcome, which is higher than that reported in literature. 43.9% had stage I endometriosis of which 38.2% conceived and 56.1% had stage II endometriosis of which 61.8% conceived. 82.4% conceived spontaneously, 32.4% within 3 months and 67.6% in 3-6 months with mean duration of 4 months. 58.5% women were treated for periadnexial adhesions altering tubo-ovarian relationship, of which 41.2% women conceived which is statistically significant.

Conclusions Large proportion of women undergoing laparoscopy surgical management of stage I and stage II endometriosis in successfully achieved a conception, spontaneously and within a short span after surgery. Pain due to endometriosis was also relieved. Favourable factors to achieve pregnancy were younger age, optimal BMI and good AMH level. Laparoscopy is an attractive and effective option for women with minimal or mild endometriosis with infertility.