Meta-analysis Of Adjuvant Medical Therapy After Conservative Surgery For Endometriosis-associated Infertility

Background: Endometriosis is a common gynaecological condition which affects approximately 10% of women of reproductive age. Surgery remains the golden standard for diagnosis of endometriosis. Unfortunately, elimination of endometriotic implants by surgical or medical treatment often provides only temporary relief. Surgical treatment of endometriosis appears to offer a significant benefit with regard of fertility outcome. Medical suppression of endometriosis for infertile patients seeking pregnancy has no proven beneficial effect.Objective: To investigate the role of medical therapy following conservative surgical treatment for endometriosis-associated infertility.Materials and Methods:1. Search strategy We searched PUBMED,MEDLINE, China National Knowledge infrastructure , Wan fang data base ,CBMdisc and reference lists of articles.2. Selection criteria Trials were included if they were randomised controlled trials of the use ofmedical therapies after surgery for endometriosis. Languages was restricted toChinese and English.3. Data collection and analysisData extraction and quality assessment was performed independently by theauthor. All the calculations and statistical tests were done with the RevMan5.0software.Main results:1. Twenty-one randomised controlled trials were identified and included in this review.2. The characteristics of inclusive studies:there are 1641 patients in all these 21 trials,21 studies reported the pregnancy rate at the end of follow-up.3. Quality of inclusive studies:among these trials,7 were considered as high quality studies, 14 were considered as low quality studies.4. Effect of the intervention:(1) Post-operative adjuvant gestrinone treatment of endometriosis compared to surgery alone showed benefit for pregnancy rate (RR= 1.37, 95%confidence interval (CI) 1.17 to 1.76).(2) The common relative risk from these randomized, controlled trial was 1.54, (95%confidence interval, 0.99 to 2.39), which suggests that the treatment effects of surgery plus postoperative GnRH-a therapy or surgery alone (either no medical therapy or placebo) were equivalent.(3) The relative risk of pregnancy rate was also not significantly different with postoperative mifepristone , clomifene, danazol or pentoxifylline treatment versus surgery alone.(4) Conclusions:Compared to surgery alone , post-operative gestrinone treatment of endometriosis showed benefit for pregnancy rate . There is insufficient evidence from the studies identified to conclude thatother medical treatment (GnRH-a, mifepristone, clomifene , pentoxifylline anddanazol) combined with surgery for endometriosis is associated with asignificant benefit with regard to pregnancy rate.