Research question

Several studies have investigated reproductive outcomes following surgical treatment of colorectal endometriosis, mainly segmental colorectal resection. This study examines pregnancy and live birth rates of women with rectosigmoid endometriosis not treated by surgery.

Design

A retrospective analysis of data collected between May 2009 and January 2020 related to 215 women affected by rectosigmoid endometriosis wishing to conceive. Patients had a diagnosis of rectosigmoid endometriosis by transvaginal ultrasonography and magnetic resonance imaging enema. Patients with estimated bowel stenosis >70% at computed tomographic colonography and/or subocclusive/occlusive symptoms were excluded.

Results

During the median length of follow-up of 31 months (range 13–63 months), the total pregnancy and live birth rates of the study population were 47.9% and 45.1%, respectively. Sixty-two women had a live birth after natural conception (28.8%; 95% confidence interval [CI] 22.8–35.6%) with a median time required to conceive of 10 months (range 2–34 months). Eighty-three women underwent infertility treatments (38.6%, 95% CI 32.1–45.5%); among these, 68 patients underwent IVF either directly (n = 51) or after intrauterine insemination (IUI) failure (n = 17). Time to conception was significantly higher in women having conceived by IVF than in those having conceived naturally (P < 0.001) or by IUI (P = 0.006). In patients undergoing IVF cycles, a worsening of some pain and intestinal symptoms was observed.

Conclusions

At median follow-up of 31 months, women with rectosigmoid endometriosis have a 48% pregnancy rate. However, these patients must be referred to centres specialized in managing endometriosis to properly assess symptoms and degree of bowel stenosis.

中文翻译：

---

未经治疗的直肠乙状结肠子宫内膜异位症患者的生育能力

研究问题

几项研究调查了结直肠子宫内膜异位症手术治疗后的生殖结果，主要是节段性结直肠切除术。本研究调查了未经手术治疗的直肠乙状结肠子宫内膜异位症女性的妊娠率和活产率。

设计

对 2009 年 5 月至 2020 年 1 月期间收集的数据进行回顾性分析，这些数据涉及 215 名受直肠乙状结肠子宫内膜异位症影响的希望怀孕的女性。患者经阴道超声和磁共振成像灌肠诊断为直肠乙状结肠子宫内膜异位症。排除在计算机断层扫描结肠成像和/或亚闭塞/闭塞症状中估计肠狭窄 >70% 的患者。

结果

在 31 个月（范围 13-63 个月）的中位随访期间，研究人群的总妊娠率和活产率分别为 47.9% 和 45.1%。62 名妇女在自然受孕后活产（28.8%；95% 置信区间 [CI] 22.8-35.6%），受孕所需的中位时间为 10 个月（范围 2-34 个月）。83 名女性接受了不孕症治疗（38.6%，95% CI 32.1–45.5%）；其中，68 名患者直接（n  = 51）或在宫内人工授精（IUI）失败后（n  = 17）接受了 IVF 。与通过自然受孕（P  < 0.001）或通过人工授精（P = 0.006）。在接受试管婴儿周期的患者中，观察到一些疼痛和肠道症状恶化。

结论

在中位随访 31 个月时，患有直肠乙状结肠子宫内膜异位症的女性妊娠率为 48%。但是，必须将这些患者转诊至专门处理子宫内膜异位症的中心，以正确评估肠狭窄的症状和程度。