Role of Laparoscopy in Diagnosis and Treatment of Endometriosis Associated with Infertility: A Prospective Analysis

Ankita  Ratan; Sujata  Pradhan; Pradip Kumar  Panigrahi; Manisha  Sahu; Pratyasha  Peepal; Somadatta  Das

doi:10.33192/Smj.2021.100

Authors

Ankita Ratan Department of Obstetrics and Gynaecology, IMS & SUM Hospital, SOA Deemed to be University, Bhubaneswar, Odisha, India.
Sujata Pradhan Center for Human Reproduction, Department of Obstetrics & Gynaecology, IMS & SUM Hospital, Siksha ‘O’ Anusandhan Deemed to be University, Bhubaneswar, Odisha, India.
Pradip Kumar Panigrahi Department of Obstetrics and Gynaecology, Sparsh Hospital and critical care, Bhubaneswar, Odisha, India.
Manisha Sahu Department of Obstetrics and Gynaecology, IMS & SUM Hospital, SOA Deemed to be University, Bhubaneswar, Odisha, India.
Pratyasha Peepal Department of Obstetrics and Gynaecology, IMS & SUM Hospital, SOA Deemed to be University, Bhubaneswar, Odisha, India.
Somadatta Das Central Research Laboratory, IMS & SUM Hospital, SOA Deemed to be University, Bhubaneswar, Odisha, India.

DOI:

https://doi.org/10.33192/Smj.2021.100

Keywords:

Laparoscopy, endometriosis, infertility, diagnosis

Abstract

Objective: Endometriosis is often considered as an enigma due to its varied clinical presentation and challenges in diagnosis. The objective of this study is to evaluate the role of laparoscopy in diagnosis and treatment of endometriosis associated with infertility.
Materials and Methods: Infertile females diagnosed to have endometriosis during or before undergoing laparoscopic surgery from August 2018 to February 2020 were followed up for spontaneous conception for 6 months following laparoscopy. Revised American Fertility Society (r-AFS) scoring system was used to score endometriosis and stage the disease (stage I-IV). Surgical interventions were done on individual cases basis following ESHRE guidelines.
Results: Fifty infertile females diagnosed with endometriosis during or before laparoscopy were recruited for the study. Mean age of patients was 28.58 (±4.21) years. Thirty-four (68%) patients had primary infertility and 16 (32%) has secondary infertility. Mean duration infertility was 3.33 (±1.43). Only 37 patients (74%) had evidence of endometriosis in pre-operative ultrasonography. During the follow up period of first 6 months after surgery 34 (68%) patients conceived spontaneously. Lower mean endometriosis score (p=0.00) and early stage of endometriosis (p=0.00) were associated with higher chances of conception. But, female age, duration and type infertility, USG findings, and type of surgical interventions did not affect pregnancy rate.
Conclusion: Laparoscopy helps in diagnosis of endometriosis. Laparoscopic therapeutic interventions for endometriosis increase the probability of spontaneous conception in infertile females. Lower surgical score and early stages of endometriosis are associated with higher chance of conception.

References

1. Eskenazi B, Warner ML. Epidemiology of endometriosis. Obstet Gynecol Clin North Am 1997;24:235-58
2. Meuleman C, Vandenabeele B, Fieuws S, Spiessens C, Timmerman D, d'Hooghe T. High prevalence of endometriosis in infertile women with normal ovulation and normospermic partners. Fertil Steril 2009; 92:68-74
3. Nnoaham KE, Hummelshoj L, Webster P, d'Hooghe T, de Cicco Nardone F, de Cicco Nardone C, et al. Impact of endometriosis on quality of life and work productivity: a multi center study across ten countries. Fertil Steril 2011; 96:366-73.
4. Piketty M, Chopin N, Dousset B, Millischer-Bellaische AE, Roseau G, Leconte M, et al. Preoperative work-up for patients with deeply infiltrating endometriosis: transvaginal ultrasonography must definitely be the first line imaging examination. Hum Reprod2009;24:602-7.
5. Practice Committee of the American Society for Reproductive Medicine. Endometriosis and infertility: a committee opinion. Fertil Steril 2012;98:591–598
6. Nisenblat V, Bossuyt PM, Farquhar C, Johnson N, Hull ML. Imaging modalities for the non-invasive diagnosis of endometriosis. Cochrane Database Syst Rev 2016; 2(2):CD009591.
7. Parazzini F. Ablation of lesions or no treatment in minimal-mild endometri-osis in infertile women: a randomized trial. Gruppo Italiano per lo Studio dell'Endometriosi. Hum Reprod 1999;14:1332-4
8. Angioni S, Cela V, Sedda F, StochinoLoi E, Cofelice V, Pontis A, et al. Focusing on surgery results in infertile patients with deep endometriosis. Gynecol Endocrinol 2015;31:595–8.
9. Nesbitt-Hawes EM, Campbell N, Maley PE, Won H, Hooshmand D, Henry A, et al. The Surgical Treatment of Severe Endometriosis Positively Affects the Chance of Natural or Assisted Pregnancy Postoperatively. Biomed Res Int 2015;2015: 438790. doi: 10.1155/2015/438790
10. Soriano D, Adler I, Bouaziz J, Zolti M, Eisenberg VH, Goldenberg M, Seidman DS, Elizur SE. Fertility outcome of laparoscopic treatment in patients with severe endometriosis and repeated in vitro fertilization failures. Fertil Steril 2016;106(5):1264-1269.
11. Ekine AA, Fulop I, Tekse I, Rucz A, Jeges S, Koppan A, et al. The surgical benefit of Hesterolaparoscopy in endometriosis-related infertility: A single centre retrospective study with a minimum 2-Year Follow-up. J of Clin Med 2020;9(507):1-12
12. Dunselman GAJ, Vermeulen N, Becker C, Calhaz-Jorge C, D'Hooghe T, De Bie B. et al. ESHRE guideline: management of women with endometriosis, Human Reproduction 2014; 29(3): 400–412
13. Valerio Mais, Stefano Guerriero, Silvia Ajossa, Marco Angiolucci, Anna Maria Paoletti, Gian Benedetto Melis, The efficiency of transvaginal ultrasonography in the diagnosis of endometrioma, Fertility and Sterility 1993;60(5):776-780
14. Fuchs F, Raynal P, Salama S, Guillot E, Le Tohic A, Chis C, Panel P. Fertilité après chirurgie cœlioscopique de l’endométriose pelvienne chez des patients en échec de grossesse. Journal de Gynécologie Obstétrique et Biologie de La Reproduction 2007; 36(4):354-359.
15. Valson H, Kulkarni C, Teli B, Nazer T. Study of endometriosis in women of reproductive age, laparoscopic management and its outcome. Int J Reprod Contracept Obstet Gynecol 2016;5:514-9
16. Saini V, Arora S, Khatri K. Study of Role of Laproscopy in Endometriosis Related Infertility and its Outcomes. International journal of scientific research, 2013;2(12):449-451
17. Porpora MG, Pultrone DC, BEllavia M, Franco C, et al. Reproductive outcome after laparoscopic treatment of endometriosis. Clin Exp Obstet Gynecol 2002;29(4):271-3.