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Against
from Section III - The Best Policy
Published online by Cambridge University Press: 25 November 2021
Operative laparoscopy has been regarded as a viable and evidence-based option for endometriosis-related infertility. However, not all studies support this conclusion and the recent synthesis of high-quality randomised controlled trials (RCTs) in a meta-analysis suggests operative laparoscopy may not be effective at improving fertility-related outcomes when compared to diagnostic laparoscopy (i.e. expectant management) in patients with endometriosis-related infertility. Only one RCT assesses the outcome of live birth rate (LBR) as a primary outcome, which was comparable in both groups (operative (10/51;19.6%) versus diagnostic (10/45;22.2%)) laparoscopy (relative risk (RR) 0.88, 95% confidence interval (CI) 0.40–1.92; very low-quality evidence). Pregnancy rate was assessed as a primary outcome in four RCTs where patients underwent operative (91/316;28.8%) or diagnostic (62/308;20.1%) laparoscopy (RR 1.38, 95%CI 0.99-1.92). Though the evidence is of moderate quality, there is insufficient evidence of a difference between the groups. There are no RCTs comparing operative laparoscopy to assisted reproductive technologies.
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