Can laparoscopic removal of deep infiltrating endometriosis lesions before the frozen embryo transfer cycle improve pregnancy outcomes in patients with recurrent implantation failure?

Abstract

Background: To evaluate the impact of laparoscopic surgery before the frozen embryo transfer (FET) cycle on pregnancy outcomes in patients with recurrent implantation failure (RIF) suffering from stage IIIIV and deep infiltrating endometriosis (DIE).

Methods and Materials: In this historical cohort study, the medical records of 121 patients with stage III and IV endometriosis and a history of RIF were evaluated. Patients included endometriosis and RIF patients who underwent laparoscopic surgery for endometriosis treatment before the FET cycle (surgery group, n = 63) and endometriosis and RIF patients who refused laparoscopic surgery had decided to have surgery to treat endometriosis (control group, n = 58). Both groups were selected after review of medical records using an observational (non-interventional) approach. Follow-up interviews with outpatients were conducted to record pregnancy outcomes.

Results: The results showed that laparoscopic removal of endometriotic lesions 4-6 months before FET cycles could significantly prolong the ongoing pregnancy (OR=2.69, 95% CI: 1.2-6.6). Live birth rates (OR=2.2, 95% CI: 0.97-4.97) in stage III-IV RIF and DIE patients. Subgroup analysis revealed that pregnancy and live birth rates did not improve in women with anti-Mullerian hormone (AMH) <0.7 ng/mL (p = 0.025).

Conclusion: Excisional laparoscopic surgery may be a useful approach to improve pregnancy outcome in RIF endometriosis patients undergoing FET cycles.