Surgical treatment of endometriosis before gamete intrafallopian transfer (GIFT)

Abstract

Objective. To determine whether active pelvic endometriosis impairs the efficacy of GIFT (gamete intrafallopian
transfer) and whether prior surgical treatment of endometriosis improves the efficacy of GIFT.
Design. Matched controlled retrospective study.
Setting. University-based assisted reproduction programme.
Patients. Patients who had GIFT between 1990 and 1997 were included in the study. Female patients
were laparoscopically diagnosed as having endometriosis. Patients who did not have surgical treatment for
endometriosis before GIFT were staged for endometriosis during the GIFT laparoscopy. Two patients, with
no signs of endometriosis, were matched for every endometriosis case, and served as controls. Patients were
matched for age, number of eggs transferred and percentage of normal sperm morphology.
Intervention. Patients in 80 cycles had surgical treatment for endometriosis and 128 patients had GIFT
procedures as treatment for endometriosis-related infertility.
Main outcome measures. Ongoing pregnancies and deliveries.
Statistical analysis. A Mantel-Haenszel approach was used to estimate relative risk of pregnancy outcome in
the endometriosis groups versus controls.
Results. There was a 22.9% pregnancy rate (11/48) among patients with active endometriosis who had GIFT
procedures, versus a 37.0% pregnancy rate (37/100) for the controls, giving a relative risk of 0.62 (95% confidence
interval (CI): 0.35 - 1.10, p = 0.082). There was a 36.3% pregnancy rate (29/80) among patients who had surgical
treatment for endometriosis before GIFT, versus a 33.3% pregnancy rate (53/159) for the controls, giving a relative
risk of 1.07 (95% CI: 0.75 - 1.54, p = 0.647).
Conclusion. There is an indication that GIFT pregnancy rates are impared in patients suffering from active
endometriosis, while prior surgery may alleviate the impairment.

South African Journal of Obstetrics and Gynaecology Vol. 13 (2) 2007: pp.42-45