Fertility after bowel resection for endometriosis

OBJECTIVE: To determine the pregnancy rate after bowel resection for rectosigmoid endometriosis. DESIGN: Prospective cohort study. SETTING: University hospital. PATIENT(S): Forty-six symptomatic women with bowel endometriosis requiring colorectal resection. INTERVENTIONS: Bowel resection by either laparoscopy or laparotomy. MAIN OUTCOME MEASURES: Pregnancy rate after surgery. RESULTS: The majority of patients underwent bowel resection by laparoscopy (71.7%). The pregnancy rate was significantly higher in women who underwent bowel resection by laparoscopy (57.6%) than in those who underwent laparotomy (23.1%; p = 0.035). The pregnancy rate was significantly higher in women who had no previous surgery for endometriosis (58.8%) than in those who had a previous laparotomy for treatment of pelvic endometriosis (15.4%; p = 0.016). No significant difference was observed in pregnancy rate and mode of conception between women with different fertility status before bowel resection. The median time between the attempt to conceive and concep- tion was 12.5 months (range, 6-46 months). Women who conceived were significantly younger than those who did not conceive; only 26.7% of women aged > or =35 years conceived after bowel resection. Uterine adenomyosis was more frequently present in women who did not conceive than in those who conceived. Infertile women who conceived had a shorter length of infertility before surgery than those who did not conceive. CONCLUSIONS: Laparoscopic colorectal resection is less likely to impact negatively on fertility than the laparotomy approach. Previous laparotomies, age > or =35 years, uterine adenomyosis, and longer duration of infertility before surgery are associated with decreased pregnancy rate.