Surgery for deep infiltrating endometriosis before in vitro fertilization: No benefit for fertility?

Objective. - Does surgery for deep infiltrating endometriosis (DIE) before in vitro fertilization (IVF) improve pregnancy and birth rate? Patients and methods. - Cohort study of 177 consecutive patients with DIE related infertility and receiving IVF. Patients were divided into 3 groups according to surgical management decided during multidisciplinary team meeting. Group no surgery (NS) (n = 65), group complete surgery (CS) with complete resection of all lesions (n = 49) and group incomplete surgery (IS) with gestures improving ovaries accessibility for IVF and/or facilitating embryonic implantation (n = 63). Pre-surgery clinical, MRI lesion locations, and history of IVF characteristics were analyzed with logistic regression. Results. - There was no significant difference in general and IVF characteristics and in the severity of endometriosis among the three groups (P = 0.43). Overall pregnancy and birth rates after IVF were 45.8% and 33.3%, respectively and were not different among the 3 groups (P = 0.59 and P = 0.49). Four major complications during oocytes retrievals were observed in NS group, one in IS group and none in CS group. Presence of an inter-utero-rectal lesion at MRI decreased the rate of pregnancy (OR = 0.49 [0.25, 0.97]). Discussion and conclusions. - Surgery for deep infiltrating endometriosis does not improve pregnancy and birth rates before IVF. This inter-utero-rectal extensive lesion might explain IVF failures by ovarian difficult access and difficulties in embryonic transfers. Further studies should explore the impact of surgical excision of inter-utero-rectal lesion on oocyte retrieval and embryonic transfer. (C) 2015 Elsevier Masson SAS. All rights reserved.