Endometriosis and assisted reproduction: the role for reproductive surgery (original) (raw)
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The impact of endometriosis on the outcome of Assisted Reproductive Technology
Reproductive biology and endocrinology : RB&E, 2017
Endometriosis has been described to impair fertility through various mechanisms. However, studies evaluating the reproductive outcomes of women undergoing assisted reproductive technologies show controversial results. The aim of this study is to assess whether the reproductive outcome is impaired among women with endometriosis-associated infertility undergoing IVF. A retrospective cohort study was performed, including women undergoing IVF reported by the Red Latinoamericana de Reproduccion Asistida (Redlara) registry, between January 2010 and December 2012. The study group included women with endometriosis-associated infertility, and the control group women with tubal factor, endocrine disorders or unexplained infertility. Women above 40 years, severe male factor and premature ovarian failure were excluded. The reproductive outcomes of between both groups were compared. The primary outcome was live birth. Secondary outcomes included clinical pregnancy, miscarriage, number of oocytes...
Assisted reproduction in endometriosis
Best Practice & Research Clinical Endocrinology & Metabolism, 2018
Practice Points • Endometriosis alter fertility by actions taking place in the pelvic cavity, ovaries and the uterus itself. • Inflammatory reactions in the pelvic cavity primarily interfere with sperm-oocyte interaction, and thus affect natural conception chances. • Surgery enhances the chances of conceiving naturally in the 12-18 months following surgery. Hence, surgery can be envisioned if there is time to wait for natural conception-ovarian reserve-and natural conception is possible (sperm, tubes). • In today's practice, lots of patients undergo IVF-first therapy because of their advanced age and therefore diagnostic laparoscopy is not routinely practiced any more. This calls for alternate methods of diagnosing endometriosis using imaging approaches-ultrasound and MRInotably. • If IVF is necessary in case of endometriosis, we recommend using an antagonist protocol with GnRH trigger and deferred embryo transfer, which limits the risk of disease flaring and optimizes results. • If IVF is opted for, there is in principle no surgery performed before IVF as this does not improve outcome and can hamper ovarian reserve. Exception to his rule of no surgery before IVF include the presence of hydrosalpinxes and very large endometrioma. Research Agenda • Classically, the treatment of endometriosis includes ovarian suppression using either GnRH agonist or the oral contraceptive (OC) pill. New research should aim at assessing the effects of ant fibrosis molecules on endometriosis, as commonly more than 50% of lesions are constituted of fibrosis. • Doubts persist as to whether implantation potential of women affected by endometriosis is altered or not in IVF. Adequately designed RCTs ought to assess the exact impact of endometriosis on implantation chances in ART. • Recent data indicate that endometriomas do not negatively affect pregnancy chances in ART. Properly designed RCTs should address this point in further details.
Shiraz E-Medical Journal, 2020
Background: The evolution of fertility treatment methods such as laparoscopic surgery and assisted reproductive technology (ART) leads to an increased chance for conception in women with endometriosis. However, it is still not clear which treatment is more likely to result in endometriosis recurrence. Objectives: The current study aimed at assessing the recurrence rate of endometriosis and its main determinants following fertility treatment with surgery or ART. Methods: The current historical cohort study was conducted on 51 consecutive women with endometriosis undergoing fertilization procedures, including laparoscopic surgery (n = 42) and ART (n = 9) in Tehran from 2006 to 2016. All patients with complete hospital records were enrolled in the study. The patients in the two groups were followed up for five years for endometriosis recurrence. Results: Within the follow-up time, the rate of endometriosis recurrence in patients of the surgery and ART groups was 28.6% and 44.4%, respec...
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...
Endometriosis and Assisted Reproductive Technology: A Review Article
Background: Endometriosis is a chronic debilitating condition which affects 6-10% of women mostly in at the peak of their reproductive age group. One of the manifestations of this incurable condition is infertility. Up to half of the women with endometriosis will be infertile. One of the means of treating endometriosis related infertility is by using assisted reproductive technology.
Endometriosis and assisted reproduction technology
2016
Endometriosis-associated infertility is poorly treatable with various forms of surgery. Therefore, assisted reproduction techniques (ARTs), such as controlled ovarian hyperstimulation, intrauterine insemination, or in vitro fertilization, are commonly used for endometriosis-associated infertility. Endometriosis impairs the efficacy of in vitro fertilization. There is no evidence that ovulation suppression before ART would enhance the efficacy of ART. Resection of minimal/mild endometriosis and/or restoration of the normality of pelvic anatomy may enhance the efficacy of ART, but aggressive ovarian surgery should be avoided, because it reduces the ovarian reserves and the likelihood of pregnancy after ART. The outcome of ART pregnancy is not affected by the history of endometriosis, but the presence of endometrioma may predispose to preterm birth or fetal growth retardation in ART-induced pregnancies. As a whole, infertility due to endometriosis is best treated with various forms of ART, and the earlier clinicians apply these techniques, the more likely pregnancy may ensue.
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.
Role of Surgery in Endometriosis-Associated Subfertility
Seminars in Reproductive Medicine, 2013
A relation between endometriosis and subfertility has long been hypothesized based on epidemiologic evidence. In fact, in large published series, the prevalence of endometriosis among women with primary infertility was 9 to 50%, 1-3 compared with 1 to 7% among women undergoing tubal ligation (i.e., in subjects with proven fertility). 1,4-7 Moreover, the monthly fecundity rate in women with endometriosis has been reported to be reduced, ranging from 2% to 10%, 8 as compared with 15 to 20% in fertile couples. Unfortunately, these epidemiologic observations constitute the only indirect evidence available concerning the association between endometriosis and subfertility. In fact, although several pathogenic mechanisms have been hypothesized, whether anatomical, biochemical, or endocrine, a causal relation has not yet been clearly demonstrated. The poor correlation observed between endometriosis stage, as evaluated by the American Society for Reproductive Medicine (ASRM) classification and reproductive performance, 12,13 seems to support the hypothesis that the distortion of the pelvic anatomy is not the sole factor involved. It is most likely that endometriosis-related subfertility results from the coexistence of different biological conditions. 9
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.