Fertility in patients with untreated rectosigmoid endometriosis

Simone Ferrero, Carolina Scala, Ennio Biscaldi, Annalisa Racca, Umberto Leone Roberti Maggiore, Fabio Barra

Research output: Contribution to journalArticlepeer-review


Research question: Several studies have investigated reproductive outcomes following surgical treatment of colorectal endometriosis, mainly segmental colorectal resection. This study examines pregnancy and live birth rates of women with rectosigmoid endometriosis not treated by surgery. Design: A retrospective analysis of data collected between May 2009 and January 2020 related to 215 women affected by rectosigmoid endometriosis wishing to conceive. Patients had a diagnosis of rectosigmoid endometriosis by transvaginal ultrasonography and magnetic resonance imaging enema. Patients with estimated bowel stenosis >70% at computed tomographic colonography and/or subocclusive/occlusive symptoms were excluded. Results: During the median length of follow-up of 31 months (range 13–63 months), the total pregnancy and live birth rates of the study population were 47.9% and 45.1%, respectively. Sixty-two women had a live birth after natural conception (28.8%; 95% confidence interval [CI] 22.8–35.6%) with a median time required to conceive of 10 months (range 2–34 months). Eighty-three women underwent infertility treatments (38.6%, 95% CI 32.1–45.5%); among these, 68 patients underwent IVF either directly (n = 51) or after intrauterine insemination (IUI) failure (n = 17). Time to conception was significantly higher in women having conceived by IVF than in those having conceived naturally (P < 0.001) or by IUI (P = 0.006). In patients undergoing IVF cycles, a worsening of some pain and intestinal symptoms was observed. Conclusions: At median follow-up of 31 months, women with rectosigmoid endometriosis have a 48% pregnancy rate. However, these patients must be referred to centres specialized in managing endometriosis to properly assess symptoms and degree of bowel stenosis.

Original languageEnglish
Pages (from-to)757-767
Number of pages11
JournalReproductive BioMedicine Online
Issue number4
Publication statusPublished - Apr 2021


  • Deep endometriosis
  • IVF
  • Natural conception
  • Pregnancy rate
  • Rectosigmoid endometriosis

ASJC Scopus subject areas

  • Reproductive Medicine
  • Obstetrics and Gynaecology
  • Developmental Biology


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