Judicial medical management of mild and minimal endometriosis in selected patients of infertility is non-inferior to surgical treatment – a retrospective analysis

Abstract

Background: Endometriosis is an enigmatic disease that affects approximately 10% of women
of reproductive age and almost 50% of women with endometriosis experience infertility.
These women experience symptoms of dysmenorrhea, premenstrual pain, dyspareunia, and
infertility, but many affected women are asymptomatic.
Objective: To analyse the clinical pregnancy rate after treating mild and minimal endometriosis
causing infertility with dienogest (2 mg) or by surgical intervention.
Materials and Methods: 146 subfertile women with mild and minimal endometriosis, enrolled
over a period of 36 months (January 2017 to December 2019) at Calcutta Fertility Mission
have been included in the present study. They were grouped in A and B and treated with
dienogest (2mg) for 90days or by laparoscopic ablation, and ovulation induction. Clinical
pregnancy rates were analysed.
Results: In our study, 18.52% of patients with early stage asymptomatic endometriosis, had
conceived spontaneously after treatment with dienogest for 3 months, and 37.04%, 44.44% had
conceived after treating them with dienogest followed by letrozole and letrozole and GnRH,
for subsequent 3-6months, respectively. 13.64% , 36.36% , 50% of women had conceived
spontaneously after laparoscopic ablation, after treating them with ablative procedure and
letrozole and with letrozole and GnRH in the next 3-6 cycles, respectively. Spontaneous
pregnancy and pregnancy following letrozole only or letrozole and GnRH in Group A and
B were also not statistically significant (p - 0.961, p - 0.698).
Conclusion: Clinical pregnancy in infertile women with early endometriosis treated with
dienogest is non-inferior to others treated with laparoscopic ablation and minimal adhesiolysis.