Impact of Surgery for Deep Endometriosis on the Outcomes of In Vitro Fertilization

This chapter summarizes the available studies on the impact of surgery for deep endometriosis (DE) on in vitro fertilization (IVF) outcomes. The literature is scarce, and there are few controlled studies with no randomized controlled trials. Based on this background, surgical excision of DE should not be offered as the first-line treatment in asymptomatic patients to improve the outcomes of IVF. However, surgical treatment of DE may be required before IVF in patients who do not tolerate pain after the discontinuation of hormonal therapies and during the ovarian stimulation, in those at risk of bowel occlusion or subocclusion during IVF and pregnancy, and in patients with hematosalpinx or hydroureter/hydronephrosis. Future randomized controlled trials with adequate power and follow-up are required to define the role of surgery for DE before IVF.