Fertility sparing endometriosis surgery: A review

Abstract

Background: Endometriosis is a chronic inflammatory condition involving endometrial-like tissue outside of the uterus. There are no medical management options available to improve fertility in patients with known endometriosis prior to conception. Specifically, the fertility sparing surgical techniques used to manage endometriomas and colorectal endometriosis are controversial prior to natural conception and implementing assisted reproductive technology. Methods: A literature search, including PubMed and the Cochrane Library, was performed from November 2020 to February 2021 and articles in English that addressed endometriosis associated infertility and surgical treatments were included. Our review provides a comprehensive evidence-based evaluation of fertility sparing endometriosis surgery. Results: The pathogenesis of endometriosis and its role in infertility is poorly understood and complex. The management of patients with painful endometriomas continues to be excision, whereas small asymptomatic endometriomas require an individualized approach. Colorectal endometriosis excision improves pregnancy rates in retrospective and prospective cohort studies. However, randomized control trials are still needed to confirm these findings and their functional risks must be carefully discussed with the patient. Conclusions: Surgical excision of endometriosis improves fertility in patients with symptomatic disease. Further research with randomized controlled trials is needed to determine if surgery is mandatory prior to implementing assisted reproductive technologies in those patients with asymptomatic endometriosis and infertility.

Keywords

• Laparoscopy
• Endometriosis
• Fertility
• Minimally invasive gynecologic surgery