Page 11 - World Journal of Laparoscopic Surgery

World Journal of Laparoscopic Surgery, January-April 2008;1(1):9-15
Role of Laparoscopic Surgery in Endometriosis Associated Infertility—Literature Review
Role of Laparoscopic Surgery in

Endometriosis Associated Infertility—

Literature Review

Ganeshselvi Premkumar
Department of Obstetrics and Gynaecology, University of Bristol, UK
Correspondence: Ganeshselvi Premkumar, 43,Larkspur Drive, Chandlers Ford, Hampshire. SO534HU
premgunny@yahoo.com, 0(44)2380267400

Abstract INTRODUCTION
Background: Endometriosis is a common disease of reproductive age
group women. It was first described by Dr Sampson in 1925 as, Endometriosis was first described in 1860 by Von Rokitansky
“presence of ectopic tissue which possesses the histological structure and endometriosis is one of the most prevalent diseases in
and function of uterine mucosa”. There is controversy surrounding its Gynecology. There is paucity of knowledge about its
pathogenesis and the mechanism by which it causes infertility. epidemiology. In addition there is also a lack of consensus on a
Laparoscopic surgery is often used to treat this condition. Controversy precise definition and pathophysiology, but recent research
exists as to the benefits of such surgery in infertile women. suggests morphological differences between endometriosis and
endometrium.
Objective: To explore whether laparoscopic surgery improves the Endometriosis can be a chronic, debilitating gynecological
chances of conception both by natural and assisted conception methods condition among women of reproductive age causing pain and
in moderate to severe endometriosis.
infertility.
The incidence of endometriosis remains unknown because
Methods: Retrospective review of English literature regarding role of
laparoscopic surgery in managing endometriosis associated infertility of the poor correlation between its presence and symptoms.
using keywords - Endometriosis, Laparoscopy, Infertility, Pregnancy The pathogenesis and mechanism by which it causes infertility
rate. is poorly understood.
Over the last two decades, there has been a large increase
Results: A large prospective study by Adamson et al 1993 showed in the number of infertile patients found to have endometriosis.
that laparoscopic surgery significantly increased the cumulative It is uncertain whether this represents an increase, or simply a
pregnancy rate which was confirmed by a further meta-analysis in reflection of the more frequent use of laparoscopy. Endometriosis
1994. A large retrospective analysis by Osuga et al 1997 reported that accounts for 10 to 15% of infertility. There is an increasing
pregnancy rate is unrelated to the stage of endometriosis. Further trend towards treating infertile with endometriosis surgically.
studies in 2002 suggested that the laparoscopic surgery increases the This review explores the evidence available particularly
pregnancy rates in the first 6-12 months post operation. Two
randomized controlled trials demonstrated higher pregnancy rates after addressing the use of laparoscopic surgery and its effect on
laparoscopic excision of endometriomata. Few studies showed the the probability of pregnancy.
benefits of laparoscopic endometrioma excision before IVF like reduced We reviewed the literature using all the available English
oocyte retrieval risks, missing occult malignancy and worsening of databases, Cochrane register and articles which addressed the
endometriosis during ovulation stimulation overweighs the drawback question “does laparoscopic surgery improve pregnancy rates
of cost and surgical risk. In addition, studies have reported improvement in women with infertility associated with moderate-severe
of dyspareunia after laparoscopic debulking for rectovaginal endometriosis?” The results are shown in Table 1.
endometriosis.
PATHOGENESIS
Conclusion: There are no large prospective randomized double blind
controlled trials available to date in this area. In spite of heterogenicity No single theory can explain the pathogenesis of endometriosis.
among the available studies, current evidence suggests that laparoscopic Endometriosis is sometimes called the disease of theories. The
1
excision or ablation, either by electrocautery or laser is beneficial in Implantation theory was first described by Dr Sampson in 1925.
improving pregnancy rates, both by natural and assisted. He proposed that retrograde menstruation regurgitates viable
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