Endometriosis and in vitro fertilisation (review) (original) (raw)
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Fertility and Sterility, 2009
Objective: To assess the use and effectiveness of IVF in a cohort of women undergoing surgery for endometriosis. Design: Cohort study. Setting: University hospital. Patient(s): Four hundred thirty-eight patients who attempted to become pregnant after conservative surgery for endometriosis. Intervention(s): Interview. Main Outcome Measure(s): Pregnancy and IVF use. Result(s): One hundred ninety-four women conceived in vivo (44%). One hundred twenty-four women did not undergo IVF despite their infertility status (51% of the group of women who failed to conceive in vivo). One hundred thirty-nine women underwent at least one IVF attempt. The cumulative rate of IVF use at 36 months of infertility was 33%. The live-birth/ongoing pregnancy rate per started cycle and per patient was 10% and 20%, respectively. Conclusion(s): In a large tertiary care and referral center, IVF played only a minor role in the treatment of endometriosis-associated infertility.
In vitro fertilization is a successful treatment in endometriosis-associated infertility
Fertility and Sterility, 2012
Objective: To assess success rates of IVF and intracytoplasmic sperm injection in women with various stages of endometriosis. Design: Retrospective cohort study. Setting: Reproductive medicine unit in a university hospital. Patient(s): Infertile women (n ¼ 2,245) with various stages of endometriosis or tubal factor infertility. Intervention(s): IVF or intracytoplasmic sperm injection. Main Outcome Measure(s): Dose of FSH, number of oocytes retrieved, fertilization rate, implantation rate, pregnancy rate (PR), live birth/ongoing PR. Result(s): Women with endometriosis had similar pregnancy and live birth/ongoing PR as did women with tubal factor infertility, but the American Society for Reproductive Medicine (ASRM) stage I and II endometriosis patients had a lower fertilization rate, and stage III and IV patients required more FSH and had fewer oocytes retrieved. Splitting the stage III and IV groups into patients with and without endometriomas showed that the endometrioma group required more FSH and had a significantly lower pregnancy and live birth/ongoing PR. Conclusion(s): With the exception of patients with endometrioma, infertile women with various stages of endometriosis have the same success rates with IVF and intracytoplasmic sperm injection as patients with tubal factor. This contrasts with the systematic review on which the European Society of Human Reproduction and Embryology bases its recommendations. (Fertil Steril Ò 2012;97:912-8. Ó2012 by American Society for Reproductive Medicine.
The Value of Assisted Reproductive Technologies in Endometriosis Associated Infertility
2016
Endometriosis, a common gynecological disease, is characterized by local and systemic inflammation, which causes pelvic pain and infertility and eventually, increased utilization of assisted reproductive technologies (ART). This methods, especially in vitro fertilization (IVF), represent efficient and useful means for women affected by endometriosis and infertility. Despite the fact that older studies suggest that in vitro fertilization outcomes are negatively affected by endometriosis, with lower pregnancy rates, recent studies show no significant differences compared to controls. Moreover, there is no clear evidence to support that treatment administration for endometriosis prior to in vitro fertilization will improve success rates, though some studies encouraged the administration of pre-in vitro fertilization cycle suppressive medical therapy in a subset of endometriosis patients. There is controversial evidence regarding removal of endometriomas as it may not have any benefit a...
Abbreviated endometriosis-associated infertility correlates with in vitro fertilization success
Journal of In Vitro Fertilization and Embryo Transfer, 1991
The utility of in vitro fertilization (IVF) for refractory infertility associated with endometriosis was studied by reviewing the 6-year experience with IVF and pregnancy follow-up at University Hospital, London, Ontario. Two hundred forty cycles were begun in 124 couples in whom endometriosis was the sole identified cause of infertility. In a program employing predominantly ultrasoundguided transvaginal oocyte retrieval, live birth rates were not reduced with advanced degrees of endometriosis. Live births were positively correlated with a shorter infertility duration.
Journal of In Vitro Fertilization and Embryo Transfer, 1988
The purpose of this report is to present a 6-year experience in the management of endometriosis with in vitro fertilization and embryo transfer (IVF/ET). We divided 136 patients who underwent 280 cycles into three groups: (1) previous history of endometriosis but normal pelvis at the time of oocyte retrieval, (2) stages I-II endometriosis (revised AFS classification), and (3) stages Ill-IV endometriosis. The stimulation protocols, estradiol (E2) responses, and distribution of terminal E 2 patterns were similar in all groups. Group 3 had significantly fewer preovulatory and immature oocytes retrieved and fewer embryos transferred. The fertilization rate and the per cycle/ per transfer pregnancy rates were similar in all groups. The miscarriage rate was higher in group 3, and the ongoing pregnancy rate per cycle was lower. Luteal phase E 2 and progesterone levels were comparable in all groups. No differences were found when groups 2 and 3 were analyzed for the presence of one or two ovaries or the presence~absence of ovarian endometriosis. The overall fertilization rate, the per cycle~per transfer pregnancy rates, and the miscarriage rate were similar to those of tubal factor patients. We underscore the excellent outcome of patients with minimal or mild endometriosis in IVF/ET. We conclude that patients with moderate or severe endometriosis have a compromised reproductive potential, probably because of a reduced oocyte recovery rate and poor embryo quality.
Reproductive outcomes of IVF after comprehensive endometriosis treatment: a prospective cohort study
Ginekologia Polska
Objectives: To evaluate the impact of pharmacological and surgical endometriosis treatment on IVF reproductive outcomes in patients with primary infertility. Material and methods: The study, conducted over a five year period, included 73 patients with endometriosis associated primary infertility subjected to 77 cycles. Group I included patients treated for endometriosis before the IVF (subgroups A: surgical and pharmacological treatment and B: only surgical treatment). Group II included patients immediately subjected to IVF. Assessed outcomes were pregnancy rate (PR) per started cycle, fertilization rate (FR), implantation rate (IR) and live birth rate (LBR). Results: Group IA included 25 patients, Group IB 21 and Group II 27 patients. FR and IR showed no significant differences between groups. PR was significantly higher in the Group I 1 than Group II (49% vs 25%, p = 0.030). PR per started cycle was the highest in the Group IA and the lowest in the Group II (p = 0.040). LBR was significantly higher in whole Group I (p = 0.043) and subgroup IA (p = 0.020) than Group II. Group IA and IB did not differ regarding examined outcomes. Regression analysis showed that endometriosis pretreatment method can impact both achieving pregnancy (p = 0.036) and having a live born child (p = 0.008) after IVF. The combined surgical and pharmacological endometriosis treatment, shorter infertility duration, lower EFI score, using long protocol with FSH+HMG gonadotropins increase the probability of successful IVF. Conclusions: A combined surgical and pharmacological endometriosis treatment had a positive impact on IVF reproductive outcomes, both on pregnancy and on live birth rates.
Australian and New Zealand Journal of Obstetrics and Gynaecology, 2012
Endometriosis is common in women with infertility but its management is controversial and varied. This article summarises the consensus developed by a group of Australasian subspecialists in reproductive endocrinology and infertility (the Australasian CREI Consensus Expert Panel on Trial evidence group) on the evidence concerning the management of endometriosis in infertility. Endometriosis impairs fertility by causing a local inflammatory state, inducing progesterone resistance, impairing oocyte release and reducing sperm and embryo transport. Medical treatments have a limited role, whereas surgical and assisted reproductive treatments improve pregnancy rates. The role of surgery for deep infiltrative endometriosis and repeat surgery requires further evaluation and there is insufficient evidence for the use of anti-adhesives to improve fertility. Intrauterine insemination (IUI) and in vitro fertilisation (IVF) improve pregnancy rates but women with endometriosis have lower pregnancy rates than those with other causes of infertility. The decision about whether to operate or pursue assisted reproduction will depend on a variety of factors such as the patient's symptoms, the presence of complex masses on ultrasound, ovarian reserve and ovarian access for IVF, risk of surgery and cost. Some women with infertility and endometriosis may benefit from a combination of assisted reproduction and surgery.
Journal of Assisted Reproduction and Genetics, 2010
Endometriosis is a debilitating condition characterized by high recurrence rates. The etiology and pathogenesis remain unclear. Typically, endometriosis causes pain and infertility, although 20-25% of patients are asymptomatic. The principal aims of therapy include relief of symptoms, resolution of existing endometriotic implants, and prevention of new foci of ectopic endometrial tissue. Current therapeutic approaches are far from being curative; they focus on managing the clinical symptoms of the disease rather than fighting the disease. Specific combinations of medical, surgical, and psychological treatments can ameliorate the quality of life of women with endometriosis. The benefits of these treatments have not been entirely demonstrated, particularly in terms of expectations that women hold for their own lives. Although theoretically advantageous, there is no evidence that a combination medical-surgical treatment significantly enhances fertility, and it may unnecessarily delay further fertility therapy. Randomized controlled trials are required to demonstrate the efficacy of different treatments.