Risk of bowel obstruction during in vitro fertilization treatment of patients with deep infiltrating endometriosis

Abstract

Introduction. Women with endometriosis often experience pain and infertility. Medical treatment interferes with the possibility of attaining pregnancy. For infertile women with endometriosis, surgery is a possible treatment, but with advanced disease there is an increased risk of serious complications. With only limited pain, women will often be referred for in vitro fertilization treatment instead. The disease is estrogen-dependent and during in vitro fertilization treatment the women could theoretically experience worsening of their symptoms. Material and methods. The study is a retrospective cohort study of 76 women with bowel endometriosis who were treated conservatively and underwent in vitro fertilization treatment. Results. Nine (11.8%) of the women experienced severe worsening of their bowel-related symptoms, including two patients presenting with colon ileus. One additional woman had no previous diagnosis of endometriosis before she presented with subocclusion of the bowel during in vitro fertilization. In all cases the in vitro fertilization treatment was stopped. Conclusions. Our study revealed that bowel endometriosis increases the risk of complications during in vitro fertilization treatment. This is in contrast to several publications. However, our study population is different due to the fact that none of these women had previous operations for bowel endometriosis. In all, 88% of the women completed fertility treatment without need for surgery.

Pain and fertility outcomes of nerve‐sparing, full‐thickness disk or segmental bowel resection for deep infiltrating endometriosis—A prospective cohort study

“…Although 11 women were lost to follow up, we observed a spontaneous PR and overall PR of 42.6% and 63.9%, respectively, and a live birth rate of 49.2%. This is in line with previous reports and underlines the beneficial effect of radical surgery for colorectal DIE on fertility, especially when taking into account that a significant percentage of infertile women with previous bowel DIE will conceive naturally and may therefore avoid IVF with its potential risks such as ovarian hyperstimulation syndrome, multiple pregnancies, exacerbation of symptoms, and/or bowel obstruction . Whether infertility in the absence of pain symptoms justifies extensive surgery in women with colorectal DIE remains highly questionable given the potential risks of surgery and satisfying outcomes of primary IVF in these women .…”

Medical treatment in the management of deep endometriosis infiltrating the proximal rectum and sigmoid colon: a comprehensive literature review

“…In fact, some cases of large bowel occlusion or perforation as well as hydroureteronephrosis have been reported during pregnancy (53)(54)(55). In fact, some cases of large bowel occlusion or perforation as well as hydroureteronephrosis have been reported during pregnancy (53)(54)(55).…”

“…Medical therapy must be evaluated with caution when managing women who will seek a conception in the short-term. In fact, some cases of large bowel occlusion or perforation as well as hydroureteronephrosis have been reported during pregnancy (53)(54)(55). Thus, the hormonal milieu of gestation may not guarantee the same lesion control usually observed during medical treatment.…”

A Rare Case of Acute Mechanical Intestinal Obstruction: Colonic Endometriosis

“…IVF therapy was terminated in all 11 patients. [15] As a result, endometriosis is a gynecological entity capable of holding all organs, and gastrointestinal placement should be kept in mind in the etiology of AMIO, especially in female patients in the reproductive period. However, in addition to case reports identified in the relevant literature on this subject, there is a need for serials and reviews with a large number of patients.…”