2025-03-28
A stress-free pregnancy?
Gynecology
#DeepInfiltratingEndometriosis #Fertility
#ColorectalSurgery #FertilityPreservation #Pregnancy
Deep infiltrating rectal endometriosis (DIRE) represents an advanced and particularly debilitating form of endometriosis, in which lesions infiltrate the rectal wall. It is often associated with severe digestive symptoms (pain during defecation, constipation, diarrhea, sub-obstructive syndrome) and infertility. For women of reproductive age with a desire for pregnancy, surgical management becomes a major therapeutic and strategic challenge.
Among available options, segmental rectal resection allows for complete removal of the affected area but involves a more invasive procedure, potentially associated with postoperative functional risks (bowel transit disorders, impaired anorectal function, urinary or sexual complications). In contrast, conservative techniques such as shaving (superficial lesion removal) or discoid resection (targeted excision of infiltrated zones) aim to minimize complications while offering satisfactory disease control, with the goal of preserving both fertility and quality of life.
In this context, the choice of surgical technique raises important questions—especially for patients whose primary goal is pregnancy.
This retrospective study assesses the true impact of these two surgical strategies on pregnancy outcomes. It compares the rates observed after radical surgery (segmental resection) versus conservative surgery, with the aim of guiding therapeutic decisions based on patients’ reproductive goals.
182 women with deep infiltrating rectal endometriosis who underwent surgery between 2009 and 2019—and had a stated desire for pregnancy—were included in the study:
A systematic two-year follow-up was conducted after surgery, collecting data on spontaneous pregnancies, use of assisted reproductive technologies (IVF, insemination), and pregnancy outcomes (ongoing, miscarriage, birth).
The goal was to measure the overall pregnancy rate (by any method) and assess whether the type of surgery had an impact on postoperative fertility. The follow-up also aimed to document postoperative complications—especially digestive and urinary—that may affect quality of life and the ability to pursue parenthood.
The results revealed no significant difference in fertility outcomes between the two groups. The overall pregnancy rate was identical, reaching 61.5% in both groups, with similar proportions of spontaneous pregnancies. However, conservative surgery was associated with fewer severe postoperative complications, suggesting a better safety profile without compromising conception rates.
Deep infiltrating rectal endometriosis is a severe form of the disease, often responsible for intense digestive pain, reduced quality of life, and infertility. Surgical treatment—often necessary—raises critical concerns for women wishing to conceive.
The main challenge lies in the choice of surgical approach: Should we opt for segmental resection, potentially more radical but also more aggressive? Or should we favor conservative techniques like shaving or discoid resection, which aim to reduce complications while preserving fertility?
The objective of this study was precisely to assess the impact of these two surgical strategies on postoperative fertility in patients desiring pregnancy, and to determine whether a less invasive approach could offer comparable—or even better—benefit-risk outcomes.
The results show that pregnancy rates were similar in both groups, exceeding 60%, whether pregnancies were spontaneous or achieved through assisted reproduction. However, conservative surgery led to significantly fewer severe complications, indicating a better tolerance profile without compromising clinical outcomes.
Nonetheless, the study has several methodological limitations, highlighting the need for prospective, controlled trials to refine surgical strategies based on individual patient priorities: symptom relief, functional preservation, and parenthood plans.
Ultimately, this study reignites a fundamental debate in endometriosis surgery: Is doing more always better for effectiveness? Or, in some cases, can doing less actually preserve more—especially when it comes to fertility?
Deep infiltrating rectal endometriosis (DIRE) represents an advanced and particularly debilitating form of endometriosis, in which lesions infiltrate the rectal wall. It is often associated with severe digestive symptoms (pain during defecation, constipation, diarrhea, sub-obstructive syndrome) and infertility. For women of reproductive age with a desire for pregnancy, surgical management becomes a major therapeutic and strategic challenge.
Among available options, segmental rectal resection allows for complete removal of the affected area but involves a more invasive procedure, potentially associated with postoperative functional risks (bowel transit disorders, impaired anorectal function, urinary or sexual complications). In contrast, conservative techniques such as shaving (superficial lesion removal) or discoid resection (targeted excision of infiltrated zones) aim to minimize complications while offering satisfactory disease control, with the goal of preserving both fertility and quality of life.
In this context, the choice of surgical technique raises important questions—especially for patients whose primary goal is pregnancy.
This retrospective study assesses the true impact of these two surgical strategies on pregnancy outcomes. It compares the rates observed after radical surgery (segmental resection) versus conservative surgery, with the aim of guiding therapeutic decisions based on patients’ reproductive goals.
Radical surgery or gentle approach: which wins for fertility?
182 women with deep infiltrating rectal endometriosis who underwent surgery between 2009 and 2019—and had a stated desire for pregnancy—were included in the study:
- 109 underwent segmental rectal resection,
- 73 had conservative surgery (shaving or discoid resection).
A systematic two-year follow-up was conducted after surgery, collecting data on spontaneous pregnancies, use of assisted reproductive technologies (IVF, insemination), and pregnancy outcomes (ongoing, miscarriage, birth).
The goal was to measure the overall pregnancy rate (by any method) and assess whether the type of surgery had an impact on postoperative fertility. The follow-up also aimed to document postoperative complications—especially digestive and urinary—that may affect quality of life and the ability to pursue parenthood.
The results revealed no significant difference in fertility outcomes between the two groups. The overall pregnancy rate was identical, reaching 61.5% in both groups, with similar proportions of spontaneous pregnancies. However, conservative surgery was associated with fewer severe postoperative complications, suggesting a better safety profile without compromising conception rates.
Read next: Chronic endometritis and recurrent reproductive failure: a systematic review and meta-analysis
Preserving the uterus without sacrificing the chances?
Deep infiltrating rectal endometriosis is a severe form of the disease, often responsible for intense digestive pain, reduced quality of life, and infertility. Surgical treatment—often necessary—raises critical concerns for women wishing to conceive.
The main challenge lies in the choice of surgical approach: Should we opt for segmental resection, potentially more radical but also more aggressive? Or should we favor conservative techniques like shaving or discoid resection, which aim to reduce complications while preserving fertility?
The objective of this study was precisely to assess the impact of these two surgical strategies on postoperative fertility in patients desiring pregnancy, and to determine whether a less invasive approach could offer comparable—or even better—benefit-risk outcomes.
The results show that pregnancy rates were similar in both groups, exceeding 60%, whether pregnancies were spontaneous or achieved through assisted reproduction. However, conservative surgery led to significantly fewer severe complications, indicating a better tolerance profile without compromising clinical outcomes.
Nonetheless, the study has several methodological limitations, highlighting the need for prospective, controlled trials to refine surgical strategies based on individual patient priorities: symptom relief, functional preservation, and parenthood plans.
Ultimately, this study reignites a fundamental debate in endometriosis surgery: Is doing more always better for effectiveness? Or, in some cases, can doing less actually preserve more—especially when it comes to fertility?
Read next: Needles for pain relief?
