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First-line surgery vs first-line ART to manage infertility in women with deep endometriosis without bowel involvement: a multi-centric propensity-score matching comparison

  • C. Ferrier
    Correspondence
    Corresponding author.
    Affiliations
    Department of Gynaecology and Obstetrics, Tenon University Hospital, Sorbonne-University, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France
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  • J.D. Hini
    Affiliations
    Department of Gynaecology and Obstetrics, Tenon University Hospital, Sorbonne-University, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France
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  • T. Gaillard
    Affiliations
    Department of Gynaecology and Obstetrics, Tenon University Hospital, Sorbonne-University, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France
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  • M. Grynberg
    Affiliations
    Department of Gynaecology and Obstetrics, Jean Verdier Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Bondy, France
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  • K. Kolanska
    Affiliations
    Department of Gynaecology and Obstetrics, Tenon University Hospital, Sorbonne-University, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France
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  • Y. Dabi
    Affiliations
    Department of Gynaecology and Obstetrics, Tenon University Hospital, Sorbonne-University, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France
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  • C. Nyangoh
    Affiliations
    Department of Gynaecology and Obstetrics, Rennes University Hospital, Rennes, France
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  • V. Lavoue
    Affiliations
    Department of Gynaecology and Obstetrics, Rennes University Hospital, Rennes, France
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  • H. Roman
    Affiliations
    Expert Center in the Diagnosis and Multidisciplinary Management of Endometriosis, Department of Gynecology and Obstetrics, Rouen University Hospital, 76031 Rouen, France
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  • E. Darai
    Affiliations
    Department of Gynaecology and Obstetrics, Tenon University Hospital, Sorbonne-University, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France

    Groupe de Recherche Clinique GRC6-UPMC : Centre Expert En Endométriose (C3E)
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  • S. Bendifallah
    Affiliations
    Department of Gynaecology and Obstetrics, Tenon University Hospital, Sorbonne-University, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France

    Groupe de Recherche Clinique GRC6-UPMC : Centre Expert En Endométriose (C3E)
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Published:November 24, 2022DOI:https://doi.org/10.1016/j.ejogrb.2022.11.013

      Abstract

      Objective

      To compare first-line surgery with first-line assisted reproductive techniques (ART) in infertile women with deep infiltrating endometriosis (DIE) without colorectal involvement.
      Study design: A retrospective comparative cohort study with a propensity-score matching analysis, in four tertiary-care referral centers. The population was infertile women with DIE without colorectal involvement. The patients were managed either by first-line surgery followed by spontaneous conception attempts and/or ART, or by first-line ART. 284 patients were extracted from the databases. After matching, 92 patients were compared in each group. Clinical pregnancy rates (PR) and live-birth rates (LBR) were the primary outcomes, and cumulative pregnancy rate (CPR) and cumulative live birth rate (CLBR) were the secondary outcomes.

      Results

      The mean number of IVF-ICSI cycles per patient was 1.4, with a significant difference between the groups: 1.6 in the first-line ART group and 1.2 in the first-line surgery group (p=0.006). The PR was significantly higher in the first-line surgery group (72% vs. 35%; p<0.001). In the first-line surgery group, non-ART pregnancies occurred in 18% (17/92) while no non-ART pregnancies was noted in the first-line ART group. The LBR was significantly higher in the first-line surgery group (61% vs. 24%; p<0.001). After ART, the CPR were 72% (47/67) in the first-line surgery group, and 35% (32/92) in the first-line ART group (p<0.001).

      Conclusion

      After matching, our results support that first-line surgery offer higher pregnancy and live-birth rates than first-line ART in patients with DIE without colorectal involvement.

      Keywords

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