Second live birth after undergoing assisted reproductive technology in women operated on for endometriosis

Capsule:
Endometriosis fertility index could be used in infertility work-up for a second live birth, after the first child was obtained through assisted reproductive technology.

Authors:
Jérémy Boujenah, M.D., Jean-Noel Hugues, M.D., Ph.D., Christophe Sifer, M.D., Isabelle Cedrin-Durnerin, M.D., Alexandre Bricou, M.D., Christophe Poncelet, M.D., Ph.D.

Volume 105, Issue 1, Pages 129-133

Abstract:

Objective:
To determine prognostic factors for a second live birth, after a first child obtained through assisted reproductive techniques (ART).

Design:
Observational study from January 2004 to December 2012.

Setting:
Tertiary care university hospital and ART center.

Patient(s):
A total of 164 infertile patients with endometriosis, who underwent laparoscopy surgery and had a first baby obtained by ART, were included and 65 wished a second baby.

Intervention(s):
No iterative surgery.

Main Outcome Measure(s):
Spontaneous pregnancy rate (PR) according to endometriosis fertility index.

Result(s):
Among the cohort, 27 patients (41.5%) gave birth to a second child through spontaneous pregnancy, whereas 23 patients (35.3%) required ART to obtain a second live birth. No difference was observed between patients regarding age, endometriosis staging, complete removal of endometriosis lesions and pelvic adhesion, except for the least function score, and the endometriosis fertility index. Taking into account irrespective of both mode of conception a total of 78% of patients obtained a second child, with a median conception time of 17 months.

Conclusion(s):
The second live birth rate in infertile patients with endometriosis and with surgical treatment was high (78%). Spontaneous PR was 54%. Endometriosis fertility index could be considered as a predictive factor for a spontaneous second pregnancy in fertility management. Our results need to be confirmed in larger prospective studies.

  • mcanis

    The paper published by Boujenah et al about the second
    live birth in women operated for endometriosis and infertility appears very
    interesting for two reasons. First it is very helpful for patients who wish to
    have a second baby after a first delivery obtained through assisted
    reproductive techniques to know that, if there were no definitive mechanical or
    male factor, their spontaneous pregnancy rate is above 40% without any
    additional treatment and that overall almost 80% of them will have a second
    baby if they accept to use ART. Second these results bring some arguments in
    favor of our hypothesis as they may suggest that endometriosis may not be a
    chronic disease. Indeed if a recurrence or a chronic inflammatory process occurred
    immediately after the end of the amenorrhea in most or all of these patients,
    the spontaneous pregnancy rate would likely be lower than 40%, a percentage
    which is close to that obtain within the first 10 months after an laparoscopic
    treatment. Indeed this pregnancy rate appears high particularly in a group of
    patients whose first baby was obtained after ART and it suggest a long term
    effect of laparoscopic surgery which consequently appear as valuable and
    effective tool in the management of endometriosis associated infertility.

    To further understand these data and their potential
    consequences on our knowledge of the natural history of the disease we would
    like to ask some complementary data to the authors.


    How long was
    the delay between the first delivery and the second pregnancy?


    How long did
    these patients used a contraception during this period?


    How many used a
    continuous oral contraception or a levonorgestrel intrauterine device ?


    How long was
    the delay between the end of their postpartum contraception and the beginning
    of the second pregnancy ?

    These data are essential to the
    readers and necessary to confirm that as suggested by the authors surgery has a
    long term effect and that consequently endometriosis may not be a chronic
    disease !!

    Boujenah
    J, Hugues JN, Sifer C, Cedrin-Durnerin I, Bricou A, Poncelet C. Second live birth after undergoing assisted reproductive technology
    in women operated on for endometriosis. Fertil Steril. 2015 Oct 19. pii:
    S0015-0282(15)02003-8. doi: 10.1016/j.fertnstert.2015.09.039.

    Canis M, Bourdel N, Houlle C, Gremeau AS, Botchorishvili R, Matsuzaki S Endometriosis may not be a chronic disease: an alternative theory offering more
    optimistic prospects for our patients. Fertil Steril. 2015 Oct 9. pii:
    S0015-0282(15)01926-3. doi: 10.1016/j.fertnstert.2015

    • Jeremy Boujenah

      Dear Canis M, Ph.PD,

      Thanks you for your contribution to the debate about the pathophysiosology of endometriosis. I read with much interest two weeks ago, your publication “Endometriosis may not be a chronic disease: an alternative theory offering more optimistic prospects for our patients”, and your 3 hypothesis

      Please find below complementary data to help you understanding the natural disease of endometriosis and provide data for your concept.

      How long was the delay between the first delivery and the second pregnancy?

      The mean time to conceive spontaneously was 8 months. For patients with ART management, the mean time was longer.

      How long did these patients used a contraception during this period?
      How many used a continuous oral contraception or a levonorgestrel intrauterine device ?
      How long was the delay between the end of their postpartum contraception and the beginning of the second pregnancy ?

      This is the most surprising data. No patients had contraception after their pregnancy because they was considered by themselves, mide-wife and doctors as infertile woman. I performed during two years a prospective follow up of these patients. When a patient gave birth after ART management for endometriosis, if no pain occured after the delivery, no contraception and a spontaneous pregancy for half of them.

      Is it a long time effect of surgery, a pregancy effect ?

      For patients with a good prognosis of spontaneous pregnancy and a complete laparoscopic treatment of endometriosis (as described by EFI score), we observed a high second spontaneous pregnancy rate.

      Endometriosis might not have reccured. However we did not performed a second laparscopy.

      Nevertheless ,The second spontaneous pregnancy rate in short delay may reflect that “endometriosis may not be a chronic disease ” as you suggested

      Please tell me if my answer help you to better understand
      Thanks you for your all publication and contributions for endometriosis research

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