Impact of surgery for colorectal endometriosis on postoperative fertility and pregnancy outcomes

Introduction: Deep infiltrative endometriosis can lead to infertility with a spontaneous pregnancy rate between 8.7 and 13%. Surgical treatment of bowel endometriosis may improve spontaneous and ART fertility. The aim of this study was to evaluate post-operative fertility according to the surgical technic used (shaving vs. bowel resection). Material and method: A retrospective, monocentric study was carried-out in the University Hospital of Strasbourg, France, from September 2009 to October 2016. All patients with a desire to become pregnant and treated for colorectal deep infiltrating endometriosis were included. Two groups were analyzed and compared: shaving treatment vs. digestive resection (discoid or segmental). The primary outcome was pregnancy rate after surgery. Secondary outcomes were: mode of pregnancy occurrence (spontaneous versus ART), time of onset, term at birth, occurrence of complications during pregnancy. Results: 94 patients were included (39 had a bowel resection and 55 a shaving). Both groups had similar preoperative characteristics. The pregnancy rate was 52,1% for the total population with no significant differences between the two groups (p = 0.68). However, we found a significantly higher spontaneous pregnancies rate among the resection group with 73.7% (p = 0,0086). Pregnancy complications occurred in 50% of pregnancies, regardless of the surgical technic used. Conclusion: This study suggests that, for patients with colorectal DIE, surgical treatment improves overall fertility. Furthermore, resection surgery seems to significantly improve the occurrence of spontaneous pregnancies. However, this surgery is not without risks and multidisciplinary discussions and thorough information to the patient are a prerequisite. (c) 2022 Elsevier Masson SAS. All rights reserved.