The efficacy of combined management of endometriosis-associated infertility

Objective:To evaluate the effectiveness of combined therapy of endometriosis-associated infertility. Materials and Methods: 69 (n = 69) patients with infertility and verified diagnosis of genital endometriosis, were included in the study. In dependence of the medication, patients were divided into two groups. I group included patients (n = 34) only with surgical treatment, group II (n = 35) - patients with combined therapy (surgical treatment + hormone therapy). After surgery patients from II group received dydrogesterone 10 mg per day from the 14th to the 25th day of the menstrual cycle, for 6 months, according to the instruction. The effectiveness of treatment was assessed by the frequency of clinical pregnancy within a year. Results: The analysis revealed statistically significant differences in the pregnancy rate. So, with the use of surgical treatment, the pregnancy rate within 6 months reached 23.5%, which is consistent with the literature, while using the combined treatment, the pregnancy rate for 6 months was 37.1% (p = 0.2195), but there were no statistically significant differences. However, after a year of follow-up in women with the combined therapy applied, the pregnancy rate was 1.5 times higher, compared to only surgical approach (N=26-76.5% versus N=15-44.1% p = 0.004 (p<0.005). However, the 12-month pregnancy rate was 1.5 times higher in the group with the complex management compared to mono-surgical treatment. Conclusions: In our opinion, considering all the pathogenetic peculiarities of endometriosis, patients with endometriosis-associated infertility require hormonal support during the second phase of the menstrual cycle, which allows to overcome the possible insufficiency of early implantation and increasing the incidence of pregnancy and improving the prediction of perinatal outcomes. © 2019, Advanced Scientific Research. All rights reserved.