Assisted reproductive technology boosts birth rate in bowel endometriosis patients

In women with bowel endometriosis, assisted reproductive technology (ART) yields satisfactory cumulative live-birth rate (LBR) with a low risk of complications, according to a study.

The study included 101 consecutive infertile bowel endometriosis patients (mean age, 32.4 years; mean infertility duration, 28.5 months) with no prior history of surgery for endometriosis who underwent 176 ART cycles over a 2-year period.

Overall, the mean Antimüllerian hormone level was 3 ng/mL, while the mean antral follicle count was 15. Eighty patients (79.2 percent) had primary infertility, 80 (79.2 percent) experienced severe dysmenorrhea, and 47 (46.5 percent) had severe gastrointestinal symptoms.

The mean number of deep-infiltrating endometriosis lesions per patient was 3, and the mean number of bowel lesions was 1.3. Bowel endometriosis was associated with endometrioma lesions in 74 patients (73.3 percent), and 89 women (88.1 percent) had associated adenomyosis.

Seventy-four women (73.3 percent) became pregnant, of whom 65 (64.4 percent) had a live birth. The cumulative LBR was 64.4 percent after four ART cycles.

There were no endometriosis-related complications documented during the ART cycles or the pregnancies. There was one unexplained intrauterine death that occurred at 25 weeks of gestation.

Given that first-line ART appears to offer satisfactory results, clinicians should carefully weigh the pros and cons before systematically referring infertile bowel endometriosis patients to fertility-preserving surgery.