Management of Infertility in Endometriosis by Operative Laparoscopy and Medical Therapy—Practiced at 3 Different Centres, from September 2005 to October 2007

Abstract

This is a prospective study conducted over a period of 2 years and 1 month (from September 2005 to October 2007). 60/117 (52.17%) patients who had laparoscopy for infertility at GMH had endometriosis. 60 patients operated for endometriosis at SHC and 40 patients managed at Anu Infertility Centre during the same period are also included in this study. All the 60 patients underwent operative laparoscopy for endometriosis. Adhesiolysis, electrocautery of surface endometriosis of the ovary, enucleation of endometriotic cyst, mobilization of ovary from uterus and pouch of Douglas and restoration of normal anatomy were carried out. Treatment interventions: Therapeutic hysteroscopy and laparoscopy, medical treatment by various ovulation induction protocols, monitoring by follicular sonography followed by pregnancy management were done in these women. Results: GMH—Seventeen 17 out of 18 coming for follow up conceived, 14 following ovulation induction and 3 after COH + IUI, by one year at GMH. SHC—14 out of 18 patients coming for follow up at the end of one year conceived, following ovulation induction 6, COH + IUI-3, IVF-3 and spontaneous 2. ANU—Out of 11 conceptions, COH + IUI resulted in 6, IVF in 4, spontaneous in 1—by one year. Pregnancy outcome: GMH: Ten delivered, Triplets in one, missed abortion two, emergency laparotomy in one. Pregnancy is continuing in 4. SHC: Eight patients delivered. Pregnancy is continuing in 4 patients. Ectopic-1, missed abortion-1. ANU: Five patients delivered. Pregnancy is continuing in 3 women, missed abortion-2, second trimester abruption-1. Discussion: The conception rate was 50% at the end of 6 months follow up (15 patients conceived out of the 30 who were coming for follow up at the end of 6 months). Fourteen (14) out of the 17 conceptions (82.35%) occurred following the use of ovulation induction drugs alone. Especially in stages I and II, if ovulation induction can yield conceptions, there is no need to refer to health centres for COH and IUI as the first option. Conclusions: Operative Hysterolaparoscopy at the same sitting would enable correction of uterine lesions to improve conception rates. From our study at GMH, we conclude that after surgery, simple treatment by ovulation induction alone can result in a high percentage of conceptions within a six-month period.