For a study, researchers sought to assess the effect of hormone suppression on fertility in infertile individuals or patients trying to conceive following endometriosis surgery. Two independent reviewers systematically searched MEDLINE, EMBASE, CENTRAL, and ClinicalTrials.gov from the beginning through December 2020. They included randomized controlled studies comparing suppressive hormonal therapy to inactive control (placebo or no treatment) following endometriosis surgery. However, they omitted studies that did not report reproductive results following surgery. PROSPERO was used to record this systematic review and meta-analysis. Using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) methodology, two reviewers gathered data and assessed the risk of bias as well as the level of evidence. The PRISMA criteria (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) were followed. A quantitative random-effect meta-analysis was used to pool relative risks (RRs). About 19 studies (2,028 patients) were chosen from 3,138 citations. Overall, there was no difference between the treatment and control groups in terms of pregnancy (RR 1.15; 95% CI 1.00–1.32) and live births (RR 1.05; 95% CI 0.84–1.32). When all hormonal medications were pooled, the duration of postoperative therapy administration was revealed as a significant source of heterogeneity between trials (I2 difference=74%), with higher risks of pregnancy when provided for at least 3 months (RR 1.22; 95% CI 1.04–1.43). GnRH agonists (14 studies, 1,721 participants) were related to an increased risk of conception compared to placebo or no therapy (RR 1.20; 95% CI 1.03–1.41; I2=25%). Other hormonal therapies have minimal data, with no meaningful difference across groups. Subgroup analyses of included studies that considered using reproductive treatments (insemination or in vitro fertilization), illness stages, and risk of bias did not change the results. Postoperative hormone suppression should be addressed on an individual basis to improve fertility while balancing the dangers of delaying pregnancy. GnRH agonists would be the preferred therapy, with a period of at least 3 months preferred.
