Recurrences and fertility after endometrioma ablation in women with and without colorectal endometriosis A prospective cohort study

Horace Roman, MD, PhD, Solene Quibel, Emmanuel Huet, MD, PhD, Jean Jacques Tuech, MD, PhD. Rouen University Hospital, France

Objective: No consensus exists on how best to manage patients presenting with ovarian endometriomas and colorectal endometriosis, in terms of impact on fertility preservation and recurrences rates. the goal of our study was to assess recurrence and pregnancy rates in women managed for ovarian endometrioma by ablation using plasma energy with and without associated surgery for colorectal endometriosis.

Methods: Prospective series of consecutive patients managed for ovarian endometriomas by ablation using plasma energy over a period of 48 consecutive months. Recurrences and pregnancy rate were compared for 52 patients presenting with colorectal endometriosis and 72 patients free of colorectal localizations. The minimum length of follow- up was 1 year. Cyst recurrences were assessed using pelvic ultrasound and MRI. Kaplan Meier and actuarial life-table analysis were used to estimate the recurrence-free survival curve, while pregnancy likelihood was assessed as a function of follow-up with 95% confidence intervals, and compared using the Log-Rank test. The Cox model was used to assess independent predictive factors for recurrences and pregnancy.

Main results: Mean follow-up was 32±18 months. 54.2% of patients had previously benefited from infertility care. Eighteen patients presented with a recurrence (14.5%). Bilateral localization of endometriomas was the only factor independently related to an increased risk in recurrences (HR 3.3, 95%CI 1.2-9.4). Of the 83 women wishing to conceive (66.9%), 52 became pregnant (62.7%), 34 spontaneously (65.4%). The rates of pregnancy were respectively 65.8% in the group of patients with associated colorectal endometriosis and 57.8% in controls (P=0.50). The probability of conceiving during the first 24 and 36 months postoperatively was 63.6% (48-79.1%) and 74.5% (56.7-89.4%) in patients with colorectal endometriosis vs. 54.6% (40.6-69.9%) and 64.1% (47.7-80.2%) in patients without colorectal involvement (P=0.87). Age over 35 was the only factor independently associated with pregnancy rates (HR 0.41, 95%CI 0.18-0.92.

Conclusions: Concomitant management of colorectal endometriosis does not impair either risk of recurrences or the probability of pregnancy in women having benefited from ovarian endometrioma ablation using plasma energy. Moreover, surgical management of colorectal and ovarian endometriosis may allow spontaneous conception in one out of three patients, thus reducing expenses related to ART management.

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