Delivery Rate following A Novel Patient Tailored Treatment Protocol Algorithm for Women with Severe Endometriosis and Infertility: Experience from One Referral Endometriosis Clinic

Introduction:

Endometriosis affect 6% to 10% of women in their reproductive years and is associated with chronic pelvic pain, dysmenorrhea and infertility. Many women with endometriosis require fertility treatment however; these treatments might cause exacerbation of endometriosis symptoms.

Aim:

To assess fertility outcome of a novel patient tailored treatment protocol algorithm for women with severe endometriosis.

Material and Methods:

All patients with severe endometriosis and infertility who were referred to one private referral endometriosis clinic from 2010 - 2015. All women underwent a comprehensive endometriosis evaluation that included: a pain score questionnaire, Three-Dimensional trans-vaginal and trans-abdominal US scan, HSG, serum FSH or AMH and sperm analysis. Patients were treated according to a patient tailored treatment protocol algorithm in order to provide the best fertility treatment and pain relief treatment indicated for each patient. The main outcome was delivery rate.

Results:

One hundred patients with severe endometriosis and infertility were referred to the referral endometriosis clinic from 2010 - 2015. The mean women age was 34.8 (±4.9) years. Following our patient tailored treatment protocol algorithm the cumulative pregnancy rate was 77.7% (77/100) and cumulative delivery rate was 68% (68/100). All women conceived following IVF treatment. The mean IVF cycles to delivery was 3.8 cycles (±2.9). Fifty five women (55%) underwent laparoscopic endometriosis surgery. Ten women (10%) delivered twins.

Conclusions:

We suggest a novel patient tailored treatment protocol algorithm combining fertility treatment and laparoscopic surgery when indicated for women with severe endometriosis and infertility. This algorithm provides good fertility outcome along with avoiding endometriosis complications.