Question 34. Does surgery for endometriosis improve pregnancy rates?

Where does all the time go? Seems like just yesterday that I was writing the last post before I went on vacation and now I realize that a whole month has passed. You may have wondered "where is Dr. Gordon?" "Why hasn't he posted a new blog that will make our day a little brighter and put a little more zip in our step?" "Why do the 6 of us keep reading this blog if he doesn't care enough about us to spend just a few minutes posting his words of wisdom?" "Why didn't I buy Apple stock at $25?" Wait that last question is the one that I keep asking myself. Not to be a name dropper but my son was in preschool in California with Steve Job's son Reed. Man, if only they had become best buddies.....unfortunately, my son thought that Reed was weird and wouldn't play with him. Apparently, when you are 3 years old it doesn't matter when some kid's father is worth 6 Billion dollars. But I digress....

So in a couple of weeks we are having a CME (doctor's continuing education) course at Fairfax Hospital. One of the questions concerns surgery for endometriosis. Guess what? No one is really sure of what to do in some of these cases. Overall, we seem to be moving away from surgery for the infertile patient, and yet, there are still occasional patients that would benefit from a laparoscopy. The problem is figuring out who would benefit from surgery and who will not. In starting to address that issue I will present today's Question of the Day from the 2nd Edition of 100 Q&A about Infertility (which is currently being printed!):

34. Does surgery for endometriosis improve pregnancy rates?

Well-designed medical studies clearly show that destroying even small implants of endometriosis can improve fertility by as much as 50%. In a large Canadian study, the monthly pregnancy rate following surgical treatment of minimal endometriosis rose from 3% to 4.5%. Although this finding represented a 50% improvement in the patients’ monthly chance of pregnancy, it does not compare very favorably with IVF pregnancy rates, which average above 30% for a single treatment cycle. Nevertheless, because treatment of endometriosis at the time of surgery does improve pregnancy rates, most surgeons will do their best to destroy endometriosis at the time of laparoscopy by using either laser or coagulation techniques. In addition to improving fertility, surgery may often eliminate or improve symptoms of dysmenorrhea and pelvic pain.

Ovarian cysts that contain endometriotic tissue may grow quite large. They are often called “chocolate cysts” because of the dark brown fluid found within them, although endometriosis cysts are more correctly referred to as endometriomas. If left untreated, these growths may destroy part or all of the normal ovarian tissue, including the eggs. Endometriomas must be surgically removed, usually via laparoscopy, as medical therapy is ineffective in the treatment of endometriomas. The ultimate choice of whether to perform a laparoscopy or laparotomy depends on the operative findings and the skill and experience of the surgeon.