Comparison of reoperation for moderate (stage III) and severe (stage IV) endometriosis-related infertility with in vitro fertilization-embryo transfer

Objective: To evaluate the efficacy of reoperation for stage III or IV endometriosis-related infertility versus IVF-ET. Design: Retrospective analysis. Setting: In vitro fertilization-embryo transfer unit and tertiary infertility clinic. Patients: Twenty-three couples with stage III or IV endometriosis-related infertility undergoing IVF-ET and 18 women undergoing reoperation for stage III or TV disease, both groups undergoing treatment after failed initial surgery to restore fertility. Results: The cumulative pregnancy rate (CPR) after reoperation for stage III or IV endometriosis-related infertility after 3, 7, and 9 months was 5.9%, 18.1% and 24.4%, respectively. The cumulative PR after one and two cycles of IVF-ET with stage III or IV endometriosis was 33.3% and 69.6%, respectively. The cumulative PR after one cycle of IVF-ET was higher than with reoperation 33.3% versus 24.4%. After two cycles the cumulative PR was significantly higher than reoperation 69.6% versus 24.4%. The mean number of oocytes retrieved was 8.5 +/- 4.6, the mean number of embryos was 4.8 +/- 2.9, and the fertilization rate was 64% +/- 21.8%. The PR per cycle, per oocyte retrieval and per ET was 38%, 42%, and 44%, respectively, with the implantation rate being 16%. The live birth rate per oocyte retrieval and per ET was 29.7% and 34.4%, respectively. No statistically significant difference could be demonstrated with regard to the fertilization, implantation, nor pregnancy or live birth rates, as compared with IVF-ET outcome with tubal infertility. Conclusion: If initial surgery fails to restore fertility in patients with moderate (stage III) or severe (stage IV) endometriosis-related infertility, IVF-ET is an effective alternative; reoperation for asymptomatic patients offers little added benefit.