A randomized study comparing triptorelin or expectant management following conservative laparoscopic surgery for symptomatic stage III-IV endometriosis

Objective: To investigate the role of adjuvant treatment with gonadotropin-releasing-hormone agonist (GnRHa) following conservative surgical treatment of endometriosis. Study design: Sixty patients in the reproductive age (mean age 28.6 years), with symptomatic stages III and IV endometriosis following laparoscopic surgery and without previous hormonal treatment were enrolled in a prospective, randomized, controlled trial to compare the effects of 3-month treatment with triptorelin depot-3.75 i.m. (30 patients) versus expectant management using placebo injection (30 patients). Results: Six patients (one in triptorelin group and five in placebo group) were lost at follow-up, the remaining 54 were suitable for analysis. Z, Pelvic pain persistence or recurrence, endometrioma relapses and pregnancy rate were evaluated during a 5-year follow-up. The results of 29 cases treated with triptorelin and 25 that received placebo did not show significant differences in pain recurrence (P = 1, RR = 0.94, 95% CI = 0.57-1.55), endometrioma relapse (P = 0.67, RR = 1.29, 95% CI = 0.66-2.50), and pregnancy rate in infertile women (P = 0.80, RR = 0.81, 95% CI = 0.37-1.80). Curves of time of pain recurrence and pregnancy during 5-year follow-up did not show significant differences between the two groups (P = 0.79 and P = 0.51, respectively, using Mantel-Haenzsel logrank test). Conclusion: Triptorelin treatment after operative laparoscopy for stage III/IV endometriosis does not appear to be superior to expectant management in terms of prevention of symptoms recurrence and endometriorna relapse, and has no influence on pregnancy rate in endometriosis-associated infertility. (C) 2006 Elsevier Ireland Ltd. All rights reserved.