Impact of surgery on fertility among patients with deep infiltrating endometriosis

Objective: The aim of the study was to investigate pregnancy and live birth rate after surgical resection of rec-tosigmoid deep infiltrating endometriosis (DIE), and study if complications affect these rates. Study design: Historical case series. 193 patients with rectosigmoid DIE and pregnancy intention undergoing a rectosigmoid resection for DIE from January 2009 to May 2019. All operations were performed at the Depart-ment of Obstetrics and Gynecology, Aarhus University Hospital, Denmark. Surgical and fertility outcome data were obtained through patient files. Anonymized data was analyzed statistically. Normally distributed contin-uous variables are stated as means, categorical data as percentages and time to pregnancy as Kaplan-Meier failure function. Live birth rates stratified on complications were tested with chi2 test.Results: 117 patients became pregnant postoperatively with a pregnancy and live birth rate of 60.6% and 53.9%, respectively. 39 patients (20.2%) became pregnant spontaneously and 78 patients (40.4%) by intrauterine insemination or assisted reproductive technologies. Median time to pregnancy after surgery was 12.4 months (range: 0.4-58). Clavien-Dindo complication grade III (none grade IV) was registered among 16.6%. These pa-tients had pregnancy and live birth rates of 50%, not statistically significantly different from those without complications.Conclusions: Postoperative pregnancy and live birth rates after resection of rectosigmoid endometriosis in this study are in line with conservative treatment, when comparing with the literature. Interestingly, complications (Clavien-Dindo grade III) did not affect live birth rate or time to pregnancy.