World Journal of Laparoscopic Surgery

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VOLUME 1 , ISSUE 1 ( January-April, 2008 ) > List of Articles

RESEARCH ARTICLE

Role of Laparoscopic Surgery in Endometriosis Associated Infertility— Literature Review

Ganeshselvi Premkumar

Citation Information : Premkumar G. Role of Laparoscopic Surgery in Endometriosis Associated Infertility— Literature Review. World J Lap Surg 2008; 1 (1):9-15.

DOI: 10.5005/jp-journals-10007-1041

Published Online: 01-04-2008

Copyright Statement:  Copyright © 2008; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Background

Endometriosis is a common disease of reproductive age group women. It was first described by Dr Sampson in 1925 as, “presence of ectopic tissue which possesses the histological structure and function of uterine mucosa”. There is controversy surrounding its pathogenesis and the mechanism by which it causes infertility. Laparoscopic surgery is often used to treat this condition. Controversy exists as to the benefits of such surgery in infertile women.

Objective

To explore whether laparoscopic surgery improves the chances of conception both by natural and assisted conception methods in moderate to severe endometriosis.

Methods

Retrospective review of English literature regarding role of laparoscopic surgery in managing endometriosis associated infertility using keywords - Endometriosis, Laparoscopy, Infertility, Pregnancy rate.

Results

A large prospective study by Adamson et al 1993 showed that laparoscopic surgery significantly increased the cumulative pregnancy rate which was confirmed by a further meta-analysis in 1994. A large retrospective analysis by Osuga et al 1997 reported that pregnancy rate is unrelated to the stage of endometriosis. Further studies in 2002 suggested that the laparoscopic surgery increases the pregnancy rates in the first 6-12 months post operation. Two randomized controlled trials demonstrated higher pregnancy rates after laparoscopic excision of endometriomata. Few studies showed the benefits of laparoscopic endometrioma excision before IVF like reduced oocyte retrieval risks, missing occult malignancy and worsening of endometriosis during ovulation stimulation overweighs the drawback of cost and surgical risk. In addition, studies have reported improvement of dyspareunia after laparoscopic debulking for rectovaginal endometriosis.

Conclusion

There are no large prospective randomized double blind controlled trials available to date in this area. In spite of heterogenicity among the available studies, current evidence suggests that laparoscopic excision or ablation, either by electrocautery or laser is beneficial in improving pregnancy rates, both by natural and assisted.


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