Abstract
OBJECTIVE: To investigate the impact of conservative laparoscopic surgery for endometriosis with postoperative gonadotropin-releasing hormone agonist (GnRHa) therapy on the pregnancy outcomes in patients with endometriosis-associated infertility. METHODS: The clinical data were collected from the patients with endometriosis-associated infertility undergoing conservative laparoscopic surgery in our department between January, 2011 and December, 2016. The patients were divided into laparoscopic surgery only group (without any other treatments) and postoperative GnRha therapy group, and the pregnancy outcomes were compared between the two groups at different time points during the follow-up. RESULTS: In cases with moderate or severe endometriosis, laparoscopic surgery with postoperative GnRha therapy was associated with a significantly higher clinical pregnancy rate than laparoscopic surgery alone (P<0.05). In patients receiving postoperative GnRha therapy, the accumulative pregnancy rates at 6, 12, 24 and 36 months after discontinuation of GnRha therapy were significantly higher than those in patients receiving laparoscopic surgery alone. The pregnancy rate following IVF-ET cycles was significantly higher than the spontaneous pregnancy rate in patients receiving conservative laparoscopic surgery alone (P<0.05), while such a difference was not found in patients with postoperative GnRHa therapy (P>0.05). CONCLUSIONS: GnRHa therapy after conservative laparoscopic surgery can significantly increase the clinical pregnancy rate in infertile 6 months women with moderate or severe endometriosis but not in mild cases. Within 6 months following laparoscopic surgery or following discontinuation of GnRHa therapy is the optimal time window for pregnancy, and a longer time from therapy discontinuation is associated with a lower possibility of spontaneous pregnancy.