Robert Jansen MD Comments on the literature. Minimal Endometriosis Should be Treated. from The New England Journal of Medicine, July 24, p. 997 The best time to destroy small areas of endometriosis is when it is diagnosed during laparoscopy (see WebPage 16, Overcoming Infertility). Yet many gynecologists dismiss minimal endometriosis as unimportant in causing infertility. (Remember that the more substantial endometriosis is, the more successful an operation will be in improving fertility.) This important multi-center trial from Canada shows that treating minimal endometriosis at laparoscopy doubles the chance of getting pregnant naturally, compared with ignoring it. Dr Sylvie Marcoux from Quebec and many colleagues studied 341 infertile women aged between 20 and 39. They were followed for 36 weeks after the laparoscopy. If you've read Appendix A of the book, you'll understand life-table curves .... "the accumulating chance of having gotten pregnant", as months go by. The Canadian authors use such graphs to show the difference between the women who were randomized to have their endometriosis lesions cauterized and the women who were randomized to no treatment: What this means is that 12 months after your diagnostic laparoscopy (assuming that minimal or mild endometriosis was found) you would have had an 8% chance of being pregnant successfully if nothing was done, but a 19% chance of being successfully pregnant if the endometriosis was treated. The per-month chance of getting pregnant (the fecundability or monthly fertility rate) was 6% with treatment at laparoscopy, 3 % without. Sure, there's more chance of getting pregnant with one cycle of IVF in a good program, but IVF can be expensive. And if you are having the laparoscopy anyway, this study proves that it is better to have the endometriosis treated on the spot. The graph in Appendix A of the book gives the vertical axis as a proportion (from 0 to 1.0); as a percentage, this would be 0 to 100%. Note that in the authors' diagram (which I have redrawn), the vertical axis is limited to 0 to 35%. For more on endometriosis, visit WebPages 15 and 16 on the main site. See the article's abstract at the National Library of Medicine. Order the U.S. version of the book from Amazon Books or Barnes and Noble. OVERCOMING INFERTILITY 474 pp softcover U.S. and International GETTING PREGNANT 482 pp softcover Australia and New Zealand
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