FEMALE INFERTILITY: Endometriosis

Fertil Steril 2002 Oct;78(4):750-6
Cycle-specific and cumulative fecundity in patients with endometriosis who are undergoing controlled ovarian hyperstimulation-intrauterine insemination or in vitro fertilization-embryo transfer.
Dmowski WP, Pry M, Ding J, Rana N.
Institute for the Study and Treatment of Endometriosis, Oak Brook, Illinois, USA. wpdmowski@oakbrookfertility.com
OBJECTIVE: To compare controlled ovarian hyperstimulation-intrauterine insemination (COH-IUI) or IVF-ET pregnancy rates per cycle (PR) and cycle and cumulative fecundity (f and cf) with COH-IUI or IVF-ET in endometriosis. DESIGN: Retrospective analysis. SETTING: Endometriosis research institute. PATIENT(S): Women with endometriosis and infertility (n = 313) who underwent consecutive COH-IUI (202 patients, 648 cycles), IVF-ET (111 patients, 139 cycles), or IVF-ET after failed COH-IUI (56 patients, 68 cycles). INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Crude PR and life table-estimated f and cf. RESULT(S): With COH-IUI, 69 patients conceived; 65 conceived with IVF-ET; and 30 conceived with IVF-ET after COH-IUI (PR 11%, 47%, and 44%). With COH-IUI, six-cycle cf was 41%, and f for cycles 1-6 was 15%, 12%, 8%, 7%, 7%, and 0. With IVF-ET, three-cycle cf was 73%, whereas f for cycles 1-3 was 47%, 27%, and 33%. First-cycle f with IVF-ET was significantly higher than cf of six COH-IUI cycles. When the data were stratified according to the stage of endometriosis and women's age, the benefit of IVF over COH was even more pronounced. Prior COH-IUI failure did not adversely affect IVF-ET outcome. CONCLUSION(S): In endometriosis, PR, f, and cf are significantly higher with IVF-ET than COH-IUI, especially in stage IV and in women >38 years of age. Considering adverse effects of prolonged ovarian stimulation on endometriosis, IVF-ET should be the first-line approach in the management of infertility in this disease. If COH-IUI is attempted, it should not exceed three to four cycles.

 

J Med Assoc Thai 2001 Jun;84 Suppl 1:S371-6
Effects of contaminated endometriotic contents on quality of oocytes. Suwajanakorn S, Pruksananonda K, Sereepapong W, Ahnonkitpanit V, Chompurat D, Boonkasemsanti W, Virutamasen P.
Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
The mechanism of infertility associated with endometriosis is poorly understood. There is evidence supporting that women with ovarian endometriosis have a lower pregnancy rate than women with peritoneal lesions only. This study aimed to evaluate the effects of endometriotic contents contamination while retrieving oocytes on oocytes' quality. Thirty-eight infertile patients with endometriotic cysts from January 1993 to June 2000 were enrolled in this study. There were no statistically significant differences among the quality of oocytes and embryos from the contaminated, non-contaminated, and control group. However, the fertilization rate and pregnancy rate were impaired by the contamination of endometriotic contents. We conclude that ovarian endometriosis should be treated before starting in vitro fertilization program in order to increase the pregnancy outcome.

 

 

J Reprod Med 2002 Oct;47(10):801-8
Impact of endometriosis on implantation. Data from the Wilford Hall Medical Center IVF-ET Program. Hickman TN.
Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Wilford Hall Medical Center, Lackland Air Force Base, Texas, USA. timothy.hickman@jhu.edu OBJECTIVE: To investigate the effect of endometriosis on implantation. STUDY DESIGN: In a retrospective cohort study, 149 consecutive in vitro fertilization retrieved cycles were analyzed. Patients with endometriosis (n = 27, 31 cycles) were compared with a control group with tubal infertility (n = 104, 118 cycles). The main outcome measure was implantation rate (gestational sac per transferred embryo). RESULTS: The patients in the tubal infertility group were slightly younger and tended to have a better response to stimulation and increased number of oocytes retrieved than did the patients in the endometriosis group; however, there were no differences in fertilization rates, number of embryos transferred or clinical pregnancy rates per cycle between the endometriosis group and tubal infertility group. The overall clinical pregnancy rate per cycle was similar for women in the endometriosis and tubal infertility groups (54.8% and 55.1%, respectively). The implantation rate was not different in the endometriosis versus tubal infertility group (28% [28/100] and 29.8%, [108/363], respectively; P = .75, relative risk = .94, 95% confidence interval .66, 1.34). CONCLUSION: For women undergoing in vitro fertilization-embryo transfer with endometriosis, the implantation rate is not markedly different from that for women undergoing in vitro fertilization-embryo transfer with tubal infertility.