The clinical significance of minimal-mild endometriosis at laparoscopy in infertile women.

Objective: The significance of the presence of minimal-mild pelvic en- dometriosis and uterine myomas in infertile women and the treatment of these conditions are still controversial. Therefore we sought to further investigate whether minimal-mild endometriosis and uterine myomas are independent risk factors for the fertility outcome of infertile women and to explore if their treatment influences the pregnancy rate. Design: Prospective cross-sectional study. Materials/Methods: Consecutive patients who had tried to conceive with- out success for at least 12 months and had no other obvious causes of infertility (i.e. anovulation, male factor) underwent laparoscopy and hyster- oscopy. Pregnancy was documented by the presence of an intrauterine gestational sac at ultrasound. Estension of endometriosis was evaluated according to the revised American Fertility Society (rAFS) scoring system. Tubal patency was assessed in all patients. Diagnosis of endometriosis was confirmed by biopsy at laparoscopy. Student t-test or Mann-Whitney U test were used for continuous variables whereas Fisher exact test was used for proportions. Results: A total of 116 patients were enrolled. Of these 47 (40.6%) patients had at least one pregnancy (group 1), while 69 did not (group 2). The age was significantly lower in group 1 than in group 2 (31.1 4.0 vs. 33.1 3.8, p 0.01). No difference was found between groups in terms of duration of infertility (median: 36 months [range: 12–132] vs. median: 36 [range: 12–180]), previous appendectomy (14 [21.3%] vs. 25 [36.2%]),previous operations on the female genital tract (2 vs. 7), pelvic adhesions at laparoscopy (8 [17.0%] vs. 16 [23.2%]), moderate-severe endometriosis (2 vs. 3), non endometriotic ovarian cysts (1 vs. 0), abnormal hysteroscopic findings (7 [14.9%] vs. 10 [14.5%]), mono/bilateral tubal patency (2 vs. 5), and minimal-mild endometriosis (19 [40.4%] vs. 30 [43.5%]). The propor- tion of patients affected only by minimal-mild endometriosis was similar between group 1 and group 2 (18 [38.3%] vs. 28 [40.6%]). Among these patients, the proportion of those who underwent an operative laparoscopy (coagulation of all visible peritoneal foci) was not different between groups (14/18 vs. 26/28). No difference was present between group 1 and group 2 in the median follow up interval, even when the analysis was restricted to patients affected only by minimal-mild endometriosis. Isolated uterine my- omas greater than 2 cm were present in 15 cases. The pregnancy rate was higher among women who had myomectomy than in those conservatively managed (6/7 vs. 1/8, p 0.05). The age and duration of infertility was similar between women who underwent myomectomy and those conserva- tively treated. Conclusions: Neither the presence of minimal-mild endometriosis nor its treatment seem to influence the pregnancy rate of infertile women. On the contrary, the removal of uterine myomas detected at laparoscopy might be useful in increasing the pregnancy rate of infertile patients.