Life table analysis of pregnancy rates in women with moderate or severe endometriosis comparing danazol therapy after carbon dioxide laser laparoscopy plus electrocoagulation or laparotomy plus electrocoagulation versus danazol therapy only

Study Objective. To assess the effectiveness, in terms of pregnancy rates, of isotopic ¹³CO₂ laser laparoscopy versus traditional laparoscopy or laparotomy in the treatment of infertile women with moderate or severe endometriosis. Design. Prospective 5-year study. Setting. Medical school- affiliated hospital. Patients. Three hundred nine infertile women with moderate to severe endometriosis. Interventions. The patients were treated with one of four options: operative laparoscopy with the ¹³ carbon dioxide (¹³CO₂) laser vaporization and/or resection, operative laparoscopy with simple electrocoagulation and sharp dissection, laparotomy with electrocoagulation and sharp dissection, and medical treatment with danazol. Estimated cumulative pregnancy rates using life table analyses were indicators of treatment of success and compared among treatments. A subgroup of 192 women considered to have endometriosis as the only infertility factor was also evaluated. Measurements and Main Results. Pregnancy rates in the laparoscopy group were equal to or higher than those of the laparotomy group, for both the entire population and the endometriosis-only subset. When the CO₂ laser was used as an adjuvant option, the rates were better, especially in patients with advanced disease and with endometriosis as the only infertility factor. Conclusion. In women with endometriosis as the only infertility factor, laparoscopic surgery with the ¹³CO₂ laser was more effective than nonlaser treatment.