Surgical Treatment of Deep Endometriosis: Impact on Spontaneous Conception

It is debated if the excision of deep endometriosis (DE) should be performed to improve natural fertility. Most of the available data in this setting are based on retrospective or prospective observational studies. These uncontrolled published studies reported a spontaneous pregnancy rate after surgery for DE of approximately 40–50%. Infertile patients with DE must be carefully informed of the actual probability of postoperative spontaneous conception and the potential morbidity associated with the proposed intervention. If surgery is performed, the procedure must be completed by laparoscopy to increase the chance of spontaneous conception. The type of infertility treatment should be tailored to the patient considering the intensity of pain symptoms, history of previous surgery, women’s age, ovarian reserve, presence of large endometriomas, tubal patency, and semen analysis.