Investigation and analysis of natural pregnancy among patients with ovarian endometriosis after conservative surgery

Objective To investigate natural pregnancy occurrence among patients with endometriosis (EMT) after conservative surgery.

Methods 116 patients with ovarian EMT admitted to Shenzhen Maternity & Child Healthcare hospital from June 2019 to January 2022 were recruited as research subjects, their data were analyzed retrospectively. The patients were divided into pregnant group and non-pregnant group according to whether they had a successful spontaneous pregnancy within 2 years after surgery. Patients' age, cyst location, body mass index (BMI), co-morbidities, cyst diameter, postoperative gonadotropin-releasing hormone agonist (GnRH-a) treatment, the revised classification American Fertility Society (r-AFS) stage, and the score of endometriosis fertility index (EFI) were analyzed. Logistic regression analysis was performed to analyze factors associated with successful natural pregnancy among patients with ovarian EMT after laparoscopic surgery.

Results After 12 to 24 months of follow-up, 55 in 116 patients (47.4%) with ovarian EMT conceive spontaneously post-surgery, while 61 cases (52.6%) failed to conceive naturally. Univariate analysis showed that spontaneous pregnancy after ovarian EMT surgery was not associated with BMI, co-morbidities and cyst diameter (P > 0.05), but it was associated with age, cyst location, postoperative GnRH-a treatment, r-AFS stage and EFI score. Logistic regression analysis showed that compared with patients aged ≤ 35 years, patients aged > 35 years had lower natural pregnancy rates(P < 0.05); Compared with patients with ovarian EMT on the left side, patients with that on the right and both sides had lower natural pregnancy rates (P < 0.05); Compared with patients who underwent postoperative GnRH-a treatment, those without GnRH-a treatment had lower natural pregnancy rates (P < 0.05); Compared with r-AFS stage Ⅰ-Ⅱ ovarian EMT patients, r-AFS stage Ⅲ and Ⅳ patients had lower natural pregnancy rates (P < 0.05). Therefore, age > 35 years old, right and bilateral cyst location, and r-AFS stage Ⅲ and Ⅳ were risk factors, while postoperative GnRH-a treatment was a protective factor for spontaneous pregnancy among patients with ovarian EMT.

Conclusion Our study suggests that senior age, bilateral cysts and progressed stage of r-AFS are risk factors, while GnRH-a treatment is protective factor for natural pregnancy after laparoscopic ovarian EMT. Early intervention measures can be carried out to improve the rate of postoperative spontaneous pregnancy.