Laparoscopic treatment of endometriosis-associated infertility and the ovarian function

Abstract

Objective: To study the influence of laparoscopic treatment of pelvic endometriosis on the ovarian function.

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Methods: The laparoscopic treatment (bipolar coagulation of endometrious heterotopies, adhesiolysis) was performed in 100 women with infertility caused by pelvic endometriosis associated with normogonadotropic normoprolactinemic ovarian insufficiency. Medicamentous therapy of endometriosis and stimulation of ovulation were not used. The ovarian function was evaluated with the help of basal body temperature, ultrasound monitoring, estimation of blood estradiol and progesterone levels before and 3-6 months after laparoscopic treatment of endometriosis.

Results: There was no restoration of ovarian ovulatory function after the treatment in 40% of patients (1^st group). The luteal insufficiency was found in 5% of patient with anovulation (2^nd group). The restoration of ovulatory menstrual cycle happened in 55% of patients (3^rd group), with 29 of them became pregnant in 2-6 months. The initial level of estradiol and progesterone in the 2^nd —3^rd groups was higher than in the 1^st group (p<0.01 and p<0.05, relatively). Positive correlation (r=0.32, p<0.001) between the progesterone level and frequency of ovulation restoration was found.

Conclusions: The restoration of ovarian ovulatory function in 55% of women after removal of endometrious heterotopies shows its great importance and the necessity of laparoscopic treatment for patients with infertility caused by pelvic endometriosis and hormonal ovarian insufficiency.