Monaz : Hello, I'm Monaz Mehta, editor in the Cochrane Editorial and Methods department. Endometriosis is a common problem for hundreds of millions worldwide and Cochrane has produced more than two dozen reviews of a variety of possible treatments. These are kept up to date as new evidence becomes available and, in October 2020, the review of laparoscopic surgery was updated. In this podcast, former fertility patient and patient advocate, Katy Lindemann from Uber Barrens Club, speaks with senior author, James Duffy from King's Fertility in the UK, about the latest findings.

Katy: Hello James, perhaps you could begin by saying a few words about why your review is so important. 

James: Hello Katy. Endometriosis is often described as an 'invisible disease', which effects approximately one in twenty women worldwide. It can affect all women and girls of a childbearing age, regardless of their race or ethnicity. Endometriosis is a condition where cells similar to the ones in the lining of the womb are found elsewhere in the body and these cells cause inflammation, pain, and the formation of scar tissue. The disease can have a huge impact on the women's lives, including causing a range of problems which can include infertility. 
One treatment option is laparoscopic, or keyhole, surgery which aims to remove deposits of endometriosis and scar tissue. This is a popular treatment choice for women with infertility associated with endometriosis and is one of the main things that we focused on in the review.

Katy: What did you find?

James: We were able to use evidence from 528 women in three randomised trials, to conclude that there is moderate quality evidence that keyhole surgery, including treatment of endometriosis, increases pregnancy rates compared to diagnostic keyhole surgery only. Unfortunately, though, there is insufficient evidence about adverse events so we cannot draw any conclusions about the safety of the procedure.  

Katy: So, what does this mean for women with infertility associated with endometriosis?

James: In general terms, keyhole surgery should be offered to women with infertility associated with endometriosis but it's also important that their preferences, circumstances, and values should inform the selection of the most appropriate treatment for them. Keyhole surgery may not be appropriate for all women, especially for those with severe endometriosis involving the bladder and bowel, and particularly complex problems should be discussed within a multi-disciplinary team.

Katy: Thanks James, and finally what should be the next steps for research that looks at endometriosis and infertility and where can people find your review if they want to learn more?

James: Thanks Katy. Our main hope for the next steps would be to see further high quality research that compares laparoscopic surgery with other treatment options, including IVF.
You can find our review online at Cochrane Library dot com and search for 'endometriosis surgery'.