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. Intervention(s): Bowel resection by either laparoscopy or laparotomy. Main Outcome Measure(s): Pregnancy rate after surgery. Result(s): The pregnancy rate was higher in women who underwent bowel resection by laparoscopy (57.6%) than in those who underwent laparotomy (23.1%). No significant difference was observed in pregnancy rate and mode of conception between women with different fertility status before bowel resection. Women who conceived were significantly younger than those who did not conceive; only 26.7% of women aged ≥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. Conclusion(s): Laparoscopic colorectal resection is less likely to impact negatively on fertility than the laparotomy approach. Previous laparotomies, age ≥35 years, uterine adenomyosis, and longer duration of infertility before surgery are associated with decreased pregnancy rate.