Pregnancy Rates after Surgical Resection of Deep Infiltrating Endometriosis in Patients with Infertility: A Systematic Review and Meta-Analysis

Objective: The aim of this review and meta-analysis was to assess spontaneous pregnancy rates after excision of deep infiltrating endometriosis (DIE) in patients with infertility. Materials and Methods: An electronic-based search was performed on PubMed, Embase, Scopus, Web of Science, and the Cochrane Database from the last 10 years. All studies, including surgical resection of DIE (>5 mm depth confirmed on pathology) and pregnancy rates published in English, French, Spanish, and Italian during the last 10 years were reviewed. Studies with only ovarian involvement were excluded. A meta-analysis was performed to calculate pooled pregnancy rates, using a random-effects model with inverse-variance weighting. The 95% confidence intervals (95% CIs) for the pregnancy rates were calculated with Wilson Score with continuity correction (WSCC). Studies with extreme heterogeneity and influence were excluded. Results: Fourteen articles fit the inclusion criteria (for estimation of overall pregnancy rates) for a total of 587 patients with a mean age of 32.4 years (2 prospective studies and 12 retrospective studies). DIE locations included the intestinal and genitourinary tracts, and other nonvisceral locations. Infertility was defined as preoperative infertility of > 1 year. Overall pregnancy rate after surgical resection was 44.8% (95% CI: 39.7%-50.1%) with a 30% (95% CI: 25%-35.5%) spontaneous pregnancy rate. Live birth rate was 41.9% (95% CI 35.2%-48.9%). Conclusions: Resection of DIE improves pregnancy rates in patients with infertility. The spontaneous pregnancy rate after surgical resection is 30%.