Does surgical treatment improve fertility?
Treating early stage endometriosis to improve fertility is controversial. Previous studies suggest that laparoscopic surgery is effective in increasing the incidence of pregnancy. A recent study by the Canadian Collaborative Group on Endometriosis demonstrates that using laparoscopy to remove diseased tissue in minimal and mild endometriosis enhances fecundity (fertility) in infertile women.
Patients in this study were recruited from a large number of Canadian health care centers. There were 348 patients who had no other cause of infertility and Stage I and II disease (early stages). Each patient in the study was randomly assigned to one of two groups: treatment by laparoscopy or no treatment by laparoscopy. The patients were then followed for 36 weeks and did not receive further treatment for fertility.
Cumulative probability of pregnancy with the treated group was 30% compared with 17% in the untreated group. The fertility rates for the treated group were 4.7% versus 2.4% for the untreated group.
Studies have not shown if excision of endometriosis is better than ablation with different energy sources. A significant number of patients with endometriosis and infertility have deep lesions (more than 10 millimeters, or 0.4 inches), especially if associated with pelvic pain. Coagulation (forcing blood vessels to clot) or laser vaporization is not recommended for patients with lesions deeper than 5 millimeters.
Does surgical treatment improve pain?
Most patients will have relief of pain with simple removal of the endometriosis. However, 20% of patients will not respond to surgery and will need further medical treatment or pain management specialists. Of those that respond, there may be a recurrence of pain over time. Hysterectomy has the least recurrence of symptoms but is the most invasive treatment.
Is laparoscopy more effective than laparotomy?
Laparoscopy and laparotomy are equally effective in relieving pain and improving fertility. Endometriosis recurs in about 20% to 30% of cases over 5 years in both procedures. Patients who undergo laparoscopy, however, experience a more rapid and less painful recovery. Deciding which surgical procedure to use should be based on the patient's preference and the physician's experience with the technique.