Judicial medical management of mild and minimal endometriosis in selected patients of infertility is non-inferior to surgical treatment – a retrospective analysis

Background: Endometriosis is an enigmatic disease that affects approximately 10% of women of reproductive age and almost 50% of women with endometriosis experience infertility. These women experience symptoms of dysmenorrhea, premenstrual pain, dyspareunia, and infertility, but many affected women are asymptomatic. Objective: To analyse the clinical pregnancy rate after treating mild and minimal endometriosis causing infertility with dienogest (2 mg) or by surgical intervention. Materials and Methods: 146 subfertile women with mild and minimal endometriosis, enrolled over a period of 36 months (January 2017 to December 2019) at Calcutta Fertility Mission have been included in the present study. They were grouped in A and B and treated with dienogest (2mg) for 90days or by laparoscopic ablation, and ovulation induction. Clinical pregnancy rates were analysed. Results: In our study, 18.52% of patients with early stage asymptomatic endometriosis, had conceived spontaneously after treatment with dienogest for 3 months, and 37.04%, 44.44% had conceived after treating them with dienogest followed by letrozole and letrozole and GnRH, for subsequent 3-6months, respectively. 13.64% , 36.36% , 50% of women had conceived spontaneously after laparoscopic ablation, after treating them with ablative procedure and letrozole and with letrozole and GnRH in the next 3-6 cycles, respectively. Spontaneous pregnancy and pregnancy following letrozole only or letrozole and GnRH in Group A and B were also not statistically significant (p - 0.961, p - 0.698). Conclusion: Clinical pregnancy in infertile women with early endometriosis treated with dienogest is non-inferior to others treated with laparoscopic ablation and minimal adhesiolysis.