# Safety and Reproductive Outcomes of Minimally Invasive Nerve-Sparing Surgery for Deep Endometriosis in Infertile Women: A One-Year Follow-Up Study

## TL;DR

Minimally invasive nerve-sparing surgery for deep endometriosis is safe and improves natural conception rates in infertile women.

## Contribution

This study provides evidence on the safety and effectiveness of nerve-sparing surgery for endometriosis in improving fertility outcomes.

## Key findings

- A 33.3% spontaneous conception rate was observed within 12 months post-surgery.
- No serious surgical complications were reported, supporting the safety of the procedure.
- Higher annual income was associated with better reproductive success.

## Abstract

Background/Objectives: Deep endometriosis is a chronic inflammatory disease that significantly affects fertility. The objective was to evaluate the magnitude of the effect of minimally invasive nerve-sparing complete excision of endometriosis on natural conception rate in women with documented infertility. Methods: This pre-planned interdisciplinary retrospective observational study included 45 patients who wished to conceive naturally (spontaneous pregnancy) and were followed for 12 months after surgery. Results: The spontaneous conception rate was 33.3% (95% CI: 20.0–46.7) and the mean time to conception was 6.7 months. Age, body mass index, and history of infertility showed no significant differences between the success and failure spontaneous pregnancy groups, but annual income was positively associated with reproductive success (p = 0.022). None of the procedures needed to be converted to open surgery, required colostomy/ileostomy, blood transfusion or abdominal drains. No cases of urinary retention were observed across different levels of nerve preservation. In addition, the absence of serious surgical complications (Clavien–Dindo III/IV) supports the safety of this intervention for infertile patients. Conclusions: The absence of serious surgical complications in this cohort supports the concept that minimally invasive nerve-sparing complete excision of endometriosis is a safe intervention when performed by an experienced team. The results underscore the importance of exploring socioeconomic-related factors through an individualized assessment of patients who wish to conceive naturally after minimally invasive nerve-sparing surgery. Future studies focusing on personalized management of endometriosis should attempt to identify socioeconomic-related covariates that influence natural conception.