Comparison of fecundity after second laparotomy for endometriosis to in vitro fertilization and embryo transfer.

OBJECTIVE

To study the prognosis for conception subsequent to a second conservative laparotomy for infertile patients with moderate and severe endometriosis, compared with the reproductive outcome of one cycle of in vitro fertilization and embryo transfer (IVF-ET).

MATERIAL AND METHOD

From January 1990 to February 2000, 190 infertile patients had initial conservative laparotomy for pelvic endometriosis at a university hospital. All of these patients had moderate or severe endometriosis. After the failure of the initial operation to restore fertility, 32 patients requested the second operation while 24 patients underwent one cycle of IVF-ET. The cumulative pregnancy rate after the second operation was compared with the clinical pregnancy rate after one cycle of IVF-ET.

RESULT

The cumulative pregnancy rate following the reoperation was 20.5% within 1 year with no additional increase in 2 and 3 years of follow up. The clinical pregnancy rate per stimulation of one cycle of IVF-ET was 12.5%. There was no statistically significant difference (P = 0.54).

CONCLUSION

Despite a trend toward a higher cumulative pregnancy rate following the second conservative laparotomy, there was no statistically significant difference, when compared with one cycle of IVF-ET in moderate and severe endometriosis-associated infertile patients who had not conceived after the initial operation.