Received July 15, 2023
Accepted January 15, 2024

Objective:To evaluate factors involved in the spontaneous pregnancy rate after endometriosis surgical treatment in patients with endometriosis and infertility. Methods:We performed a retrospective study, from 2014 to 2020 of 2 years follow-up of patients with endometriosis-related infertility and laparoscopic surgery. Women age 25 to 43 with patent tubes, no/mild male factor and no other infertility factors were selected and grouped according fertility management as: patients that used ART immediately (16.5%, ART-p); patients that waited (83.5%) and achieved spontaneous pregnancy (71.8% SP-p) or waited and subsequentially required ART (28.2%, NSP-p). Results:A total of 200 patients were analyzed. Of 167 patients that waited for spontaneous pregnancy, 71.8% achieved it. We observed a tendency of higher EAS on ART-p group compared with patients that waited for a spontaneous pregnancy, and lower EAS in those that achieved spontaneous pregnancy. When we studied how long it took to achieve pregnancy, we observed that SP-p achieved pregnancy in 5.7 months while NSP-p took 1.8 times more than SP-p (p<0.001). However, after treatment changed to ART, NSP-p achieve pregnancy in a similar time than SP-p. Therefore, to identify earlier these group we performed a multivariable approach and developed a decision tree (81.3% accuracy and 53.3% sensitivity). Conclusions: The present results indicate that, after surgical treatment, the majority of patients achieved a spontaneous pregnancy. Moreover, using a decision tree algorithm we now can identify early patients that will probably require ART, decreasing the time between surgery and pregnancy and improving the general outcome.