12329 Effectiveness of Surgery for Infertile Women With Advanced Stage Endometriosis: A Systematic Review and Meta-Analysis
Bibliographic record
Abstract
Study Objective To compare pregnancy rates in women with advanced stage endometriosis suffering infertility undergoing surgery vs in vitro fertilization (IVF) treatments. Design Systematic review and meta-analysis. Setting Tertiary medical center. Patients or Participants 120 reviewed abstracts. Interventions Following PRISMA guidelines, MEDLINE, Embase, and Cochrane databases were searched for studies investigating the effects of surgical treatments on fertility in patients with moderate to severe endometriosis. Comprehensive meta-analysis software was used for meta-analysis and heterogeneity assessment. The risk of bias in non-randomized studies was evaluated using the Newcastle-Ottawa Scale (NOS). Measurements and Main Results Out of 120 reviewed abstracts, we screened 86 full-text articles. Five studies comparing surgical treatment to IVF met the inclusion criteria for the meta-analysis. Although the results of the meta-analysis suggested a higher likelihood of pregnancy post-surgery compared to IVF alone, statistical significance was not achieved (RR, 1.34 [95% CI, 0.91-1.57, p=0.24). High heterogeneity among studies was observed. Four studies preferred surgery pre-IVF, while one indicated no benefit and had the lowest NOS score. In a separate analysis including 49 observational studies, spontaneous pregnancy rate post-surgery was compared with IVF treatment outcomes. The event rate for spontaneous pregnancies after surgery was 0.315 (95% CI, 0.274-0.358), whereas the event rate for IVF pregnancies after surgery was 0.264 (95% CI, 0.234-0.296). Conclusion While a meta-analysis of comparative studies did not reveal statistically significant differences in pregnancy rates between surgical treatment and IVF, a meta-analysis of observational studies demonstrated higher rates of spontaneous pregnancies after surgery compared to pregnancies after IVF. Randomized Controlled Studies are needed to better understand the effect of surgery on spontaneous and IVF conception for women with advanced stage endometriosis.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.013 | 0.028 |
| Meta-epidemiology (narrow) | 0.003 | 0.002 |
| Meta-epidemiology (broad) | 0.018 | 0.045 |
| Bibliometrics | 0.007 | 0.007 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.005 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".