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.

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