Surgical treatment of endometriosis before gamete intrafallopian transfer (GIFT)

Objective. To determine whether active pelvic endometriosis impairs the efficacy of GIFT (gamete intrafallopian transfer) and whether prior surgical treatment of endometriosis improves the efficacy of GIFT. Design. Matched controlled retrospective study. Setting. University-based assisted reproduction programme. Patients. Patients who had GIFT between 1990 and 1997 were included in the study. Female patients were laparoscopically diagnosed as having endometriosis. Patients who did not have surgical treatment for endometriosis before GIFT were staged for endometriosis during the GIFT laparoscopy. Two patients, with no signs of endometriosis, were matched for every endometriosis case, and served as controls. Patients were matched for age, number of eggs transferred and percentage of normal sperm morphology. Intervention. Patients in 80 cycles had surgical treatment for endometriosis and 128 patients had GIFT procedures as treatment for endometriosis-related infertility. Main outcome measures. Ongoing pregnancies and deliveries. Statistical analysis. A Mantel-Haenszel approach was used to estimate relative risk of pregnancy outcome in the endometriosis groups versus controls. Results. There was a 22.9% pregnancy rate (11/48) among patients with active endometriosis who had GIFT procedures, versus a 37.0% pregnancy rate (37/100) for the controls, giving a relative risk of 0.62 (95% confidence interval (CI): 0.35 - 1.10, p = 0.082). There was a 36.3% pregnancy rate (29/80) among patients who had surgical treatment for endometriosis before GIFT, versus a 33.3% pregnancy rate (53/159) for the controls, giving a relative risk of 1.07 (95% CI: 0.75 - 1.54, p = 0.647). Conclusion. There is an indication that GIFT pregnancy rates are impared in patients suffering from active endometriosis, while prior surgery may alleviate the impairment.