Effect of Postoperative Hormonal Suppression on Fertility in Patients With Endometriosis After Conservative Surgery: A Systematic Review and Meta-analysis.

OBJECTIVE: To evaluate the effect of hormonal suppression on fertility when administered to infertile patients or patient wishing to conceive after surgery for endometriosis. DATA SOURCES: A systematic search of MEDLINE, EMBASE, CENTRAL and ClinicalTrials.gov was performed by two independent reviewers from the databases' inception until December 2020. METHODS OF STUDY SELECTION: We included randomized controlled trials comparing any suppressive hormonal therapy to an inactive control (placebo or absence of treatment) after conservative surgery for endometriosis. Studies that did not report fertility outcomes after surgery were excluded. TABULATION, INTEGRATION AND RESULTS: This systematic review and meta-analysis was registered in PROSPERO. Two reviewers extracted data and assessed the risk of bias as well as the strength of evidence using GRADE (Grading of Recommendations, Assessment, Development and Evaluation) methodology. PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines were followed. Relative risks (RRs) were pooled by quantitative random effect meta-analysis. From 3,138 citations, 19 trials (2,028 patients) were included. Overall, no difference was observed between the treatment and the control group for pregnancy (RR 1.15; 95% CI 1.00-1.32) and live births (RR 1.05; 95% CI 0.84-1.32). When pooling all hormonal therapies, the duration of administration of postoperative therapy was identified as a substantial source of heterogeneity between studies (I2 difference=74%) with increased chances of pregnancy compared with control when administered for at least 3 months (RR 1.22; 95% CI 1.04-1.43). Gonadotropin-releasing hormone (GnRH) agonists (14 trials, 1,721 patients) were associated with increased chances of pregnancy compared with placebo or no treatment (RR 1.20; 95% CI 1.03-1.41; I2=25%). Data were limited for other hormonal treatments with no significant difference between groups. Subgroup analyses taking into account the use of fertility treatments (insemination or in vitro fertilization), stages of the disease and risk of bias of included trials did not modify the results. CONCLUSION: Postoperative hormonal suppression should be considered on a case-by-case basis to enhance fertility while balancing this benefit with the risks of delaying conception. If chosen, GnRH agonists would be the treatment of choice, and a duration of at least 3 months should be favored. SYSTEMATIC REVIEW REGISTRATION: PROSPERO, CRD42021224424.

Translation and Cultural Validation of the WERF EPHect Endometriosis Patient Questionnaire into Canadian French.

OBJECTIVE: To produce a culturally validated Canadian French version of the Standard EPHect Endometriosis Patient Questionnaire (EPQ-S) from the World Endometriosis Research Foundation (WERF). METHODS: We studied 17 premenopausal women who were seen for pelvic pain symptoms or suspicion of endometriosis at the gynaecology clinic of the CHU de Québec - Université Laval (Québec City, Canada). Participants completed the French language version of the questionnaire at their first visit, and the validation took place about 1 week later. RESULTS: All 22 of the invited women agreed to participate, of whom 17 were reached for the validation. The mean age of participants was 38.9 years, and 15 (88%) had a confirmed diagnosis of endometriosis. Fourteen participants (82%) found the questionnaire clear and relevant. The average length of time to complete the questionnaire was 36.25 ± 10.8 minutes. The validation process resulted in the addition of lines at the end of each section to allow space for specific comments and some clarifications with respect to timelines. CONCLUSION: This study validated a Canadian French version of the EPHect questionnaire. With such validation studies, differences in language and culture will no longer be a barrier to large national and international studies on endometriosis, leading to high-quality research and breakthroughs for millions of individuals living with this disease.