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Blank C, Deboever C, Decroos E, DeCroo I, Tilleman K, De Sutter P, Mischi M, Schoot BC. Impaired implantation in endometriosis compared with couples with male subfertility after transfer of equal quality embryos: a matched cohort study. Reprod Biomed Online 2020; 42:S1472-6483(20)30467-3. [PMID: 34756367 DOI: 10.1016/j.rbmo.2020.08.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 07/19/2020] [Accepted: 08/25/2020] [Indexed: 02/07/2023]
Abstract
RESEARCH QUESTION Is implantation impaired in patients with endometriosis undergoing IVF and intracytoplasmatic sperm injection (ICSI) cycles? DESIGN A retrospective matched cohort study was carried out on IVF/ICSI cycles with fresh single embryo transfer at the Department of Assisted Reproductive Medicine, Ghent University Hospital, Belgium, between July 2015 and August 2017 (n = 1053). A total of 118 endometriosis cases were matched 1:1 to 118 couples diagnosed with male subfertility and stratified by embryo quality (identical ALPHA grading categories), female age (±1 year) and parity (±1 delivery). Transvaginal ultrasound, magnetic resonance imaging or laparoscopy was used to diagnosed endometriosis, and the revised American Society for Reproductive Medicine score was used to classify the endometriosis into grade I/II versus grade III/IV. Male subfertility was defined in accordance with World Health Organization criteria (fifth edition). RESULTS Compared with endometriosis cases, control couples with male subfertility had significantly higher rates of positive HCG test on day 16 (P = 0.047, OR 2.077, CI 1.009 to 4.276), ongoing implantation (defined as a positive fetal heart rate on transvaginal ultrasound at a gestational age of at least 6.5-7 weeks) (P = 0.038, OR 2.265, CI 1.048 to 4.893), ongoing pregnancy (defined by a vital pregnancy at 11 weeks) (P = 0.046, OR 2.292, CI 1.016 to 5.173) and live birth (P = 0.043, OR 2.502, CI 1.029 to 6.087). CONCLUSIONS After matching for embryo quality, woman's age and parity, rates of positive HCG tests, ongoing implantation, ongoing pregnancy and live birth were more than twice as high in the control group compared with the endometriosis group.
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Affiliation(s)
- Celine Blank
- Department of Reproductive Medicine, Ghent University Hospital, De Pintelaan 185 9000, Ghent, Belgium; Department of Electrical Engineering (Signal Processing Systems), Eindhoven Technical University, 19, Flux, Postbus 513 Postal code: 5600 MB, Eindhoven, the Netherlands; Department of Obstetrics and Gynecology, Catharina Hospital, Michelangelolaan 2 5623 E, Eindhoven, the Netherlands.
| | - Charlotte Deboever
- Department of Reproductive Medicine, Ghent University Hospital, De Pintelaan 185 9000, Ghent, Belgium
| | - Eva Decroos
- Department of Reproductive Medicine, Ghent University Hospital, De Pintelaan 185 9000, Ghent, Belgium
| | - Ilse DeCroo
- Department of Reproductive Medicine, Ghent University Hospital, De Pintelaan 185 9000, Ghent, Belgium
| | - Kelly Tilleman
- Department of Reproductive Medicine, Ghent University Hospital, De Pintelaan 185 9000, Ghent, Belgium
| | - Petra De Sutter
- Department of Reproductive Medicine, Ghent University Hospital, De Pintelaan 185 9000, Ghent, Belgium
| | - Massimo Mischi
- Department of Electrical Engineering (Signal Processing Systems), Eindhoven Technical University, 19, Flux, Postbus 513 Postal code: 5600 MB, Eindhoven, the Netherlands
| | - Benedictus Christiaan Schoot
- Department of Reproductive Medicine, Ghent University Hospital, De Pintelaan 185 9000, Ghent, Belgium; Department of Electrical Engineering (Signal Processing Systems), Eindhoven Technical University, 19, Flux, Postbus 513 Postal code: 5600 MB, Eindhoven, the Netherlands; Department of Obstetrics and Gynecology, Catharina Hospital, Michelangelolaan 2 5623 E, Eindhoven, the Netherlands
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Barbosa MAP, Teixeira DM, Navarro PAAS, Ferriani RA, Nastri CO, Martins WP. Impact of endometriosis and its staging on assisted reproduction outcome: systematic review and meta-analysis. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2014; 44:261-278. [PMID: 24639087 DOI: 10.1002/uog.13366] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2013] [Revised: 02/24/2014] [Accepted: 02/28/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To evaluate whether the presence or severity of endometriosis affects the outcome of assisted reproductive techniques (ART). METHODS In this systematic review, all studies comparing the outcome of ART in women with and those without endometriosis, or at different stages of the disease, were considered eligible. We used either risk ratio (RR) or mean difference (MD) and their 95%CIs for comparisons. The primary outcome was live birth; the secondary outcome was clinical pregnancy. Miscarriage and the number of oocytes retrieved were examined as additional outcomes. RESULTS We included 92 studies in the review and 78 in the meta-analysis: 20,167 women with endometriosis were compared with 121,931 women without endometriosis, and 1703 women with Stage-III/IV endometriosis were compared with 2227 women with Stage-I/II endometriosis. The following results were observed for the comparison of women with endometriosis vs women without endometriosis: live birth, RR = 0.99 (95%CI, 0.92-1.06); clinical pregnancy, RR = 0.95 (95%CI, 0.89-1.02); miscarriage, RR = 1.31 (95%CI, 1.07-1.59); number of oocytes retrieved, MD = -1.56 (95%CI, -2.05 to -1.08). The following results were observed for the comparison of women with Stage-III/IV vs Stage-I/II endometriosis: live birth, RR = 0.94 (95%CI, 0.80-1.11); clinical pregnancy, RR = 0.90 (95%CI, 0.82-1.00); miscarriage, RR = 0.99 (95%CI, 0.73-1.36); number of oocytes retrieved, MD = -1.03 (95%CI, -1.67 to -0.39). CONCLUSIONS Women with endometriosis undergoing ART have practically the same chance of achieving clinical pregnancy and live birth as do women with other causes of infertility. No relevant difference was observed in the chance of achieving clinical pregnancy and live birth following ART when comparing Stage-III/IV with Stage-I/II endometriosis. The quality of the evidence for the additional examined outcomes was very low, not allowing meaningful conclusions to be drawn.
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Affiliation(s)
- M A P Barbosa
- Department of Obstetrics and Gynecology, Medical School of Ribeirao Preto, University of Sao Paulo (FMRP-USP), Ribeirao Preto, Brazil
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de Carvalho BR, Rosa-e-Silva ACJDS, Rosa-e-Silva JC, dos Reis RM, Ferriani RA, Silva-de-Sá MF. Increased basal FSH levels as predictors of low-quality follicles in infertile women with endometriosis. Int J Gynaecol Obstet 2010; 110:208-12. [PMID: 20553681 DOI: 10.1016/j.ijgo.2010.03.033] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2009] [Revised: 03/24/2010] [Accepted: 04/19/2010] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To determine whether basal levels of follicle-stimulating hormone (FSH) and anti-müllerian hormone (AMH), antral follicle count (AFC), and the numbers of dominant follicles, oocytes, and mature oocytes retrieved after ovarian stimulation differed between infertile women with endometriosis and healthy women undergoing assisted reproduction techniques (ART). METHOD Of 77 consecutive ART candidates, 27 were infertile and had endometriosis. A male factor caused the infertility of the other 50, who acted as controls. RESULTS The AMH and AFC levels were similar in the 2 groups. The FSH levels were higher (8.28 mIU/mL [range, 5.25-24.1 mIU/mL] vs 5.91 mIU/mL [range, 2.47-18.7 mIU/mL]; P<0.01) in the study group. And the numbers of retrieved (n=5 [range, 0-12] vs n=9 [range, 0-27; P<0.05) and mature oocytes (n=4 [range, 0-11] vs n=5 [range, 0-16]; P<0.05) were less in the study group. CONCLUSION Because AMH levels were unchanged, endometriosis seems not to damage the primordial pool of follicles and oocytes, but to lessen the quality of the ovarian response to the hCG injection. Basal FSH levels may be of value in predicting ART success in women with the disease.
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Affiliation(s)
- Bruno Ramalho de Carvalho
- Service of Human Reproduction, Department of Gynecology and Obstetrics, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, São Paulo, Brazil.
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4
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Pabuccu R, Onalan G, Kaya C. GnRH agonist and antagonist protocols for stage I–II endometriosis and endometrioma in in vitro fertilization/intracytoplasmic sperm injection cycles. Fertil Steril 2007; 88:832-9. [PMID: 17428479 DOI: 10.1016/j.fertnstert.2006.12.046] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2006] [Revised: 12/25/2006] [Accepted: 12/29/2006] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To investigate the outcomes of intracytoplasmic sperm injection (ICSI) cycles after controlled ovarian hyperstimulation (COH) with GnRH antagonist or GnRH agonist (GnRH-a) in mild-to-moderate endometriosis and endometrioma. DESIGN Prospective randomize trial. SETTING A private IVF center. PATIENT(S) A total of 246 ICSI cycles in 246 patients were divided into three groups: women with mild-to-moderate endometriosis (n = 98); women who had ovarian surgery for endometrioma (n = 81); women with endometrioma and no history of previous surgery (n = 67). INTERVENTION(S) Patients in each group were randomized to COH with either triptrolein or cetrorelix. MAIN OUTCOME MEASURE(S) Clinical parameters, characteristics of COH, and ICSI results were analyzed. RESULT(S) Outcomes of COH with both GnRH antagonist and GnRH-a were similar in patients with mild-to-moderate endometriosis. Implantation rates were 15.9% vs. 22.6% and clinical pregnancy rates were 27.5% vs. 39% with GnRH antagonist and GnRH-a protocols, respectively, in patients who had ovarian surgery for endometrioma. Implantation rates were 12.5% vs. 14.8% and clinical pregnancy rates were 20.5% vs. 24.2% with GnRH antagonist and GnRH-a protocols, respectively, in patients with endometrioma and no history of ovarian surgery. CONCLUSION(S) Considering the implantation and clinical pregnancy rates, COH with both GnRH antagonist and GnRH-a protocols may be equally effective in patients with mild-to-moderate endometriosis and endometrioma who did and did not undergo ovarian surgery.
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Affiliation(s)
- Recai Pabuccu
- Ufuk University School of Medicine, Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Ankara, Turkey
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Pouly JL, Canis M, Velemir L, Brugnon F, Rabischong B, Botchorichvili R, Jardon K, Peikrishvili R, Mage G, Janny L. La stérilité par endométriose. ACTA ACUST UNITED AC 2007; 36:151-61. [PMID: 17267133 DOI: 10.1016/j.jgyn.2006.12.009] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
From the literature, the crucial knowledge were drawn among endometriosis related infertility. Endometriosis is an important factor of infertility in minimal or light stages and a major one in mild or moderate stages. Thus, a laparoscopy must be performed to confirm endometriosis when suggestive clinical or biological signs exist. In absence of them, laparoscopy can be delayed after intra-uterine inseminations (IUI). The first line treatment is laparoscopic surgery. Its efficacy is proven. It is useless to prescribe a post-operative medical treatment (GnRH analogues). Surgery leads to 25 to 40% of deliveries. It is dependant on age, infertility duration, tubo-ovarian adhesion and tubes involvement. But, surgery can be avoided and the patient is directly referred to In Vitro Fertilization (IVF) when the lesions extension is so important that surgery exposes to complications or when there is a permanent other indication for IVF (severe male infertility). When infertility persists 6 to 12 months after surgery and without patent recurrence, ovulation stimulations and IUI are performed as the second line treatment. After IUI failure, or in case of recurrence, IVF must be applied. A second surgery is not recommended. The IVF results are not impaired by the presence of endometriosis and even of endometriomas. Thus, it is useless to operate again endometriosis before IVF. In opposition, in severe stages or in cases of recurrence, a pre-IVF medical treatment (GnRH analogues) improves the results. IVF do not increased the risk of endometriosis acute growth. In case of infertility and pain, infertility is considered as the first target. But medical treatment can be prescribed between the IVF attempts.
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Affiliation(s)
- J-L Pouly
- Département de Gynécologie - Obstétrique et de Reproduction Humaine, Polyclinique Hôtel-Dieu, CHU de Clermont-Ferrand, BP 69, 63003 Clermont-Ferrand, France.
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De Hondt A, Meuleman C, Tomassetti C, Peeraer K, D'Hooghe TM. Endometriosis and assisted reproduction: the role for reproductive surgery? Curr Opin Obstet Gynecol 2006; 18:374-9. [PMID: 16794415 DOI: 10.1097/01.gco.0000233929.27145.f3] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW The aim of this review paper is to discuss the relationship between endometriosis and assisted reproductive technology. More specifically, the following clinically relevant issues will be discussed. (1) Does the presence of endometriosis affect the outcome of assisted reproductive technology? (2) Does surgical treatment for endometriosis prior to or after assisted reproductive technology treatment affect the outcome of assisted reproductive technology? (3) Is assisted reproductive technology a risk factor for the recurrence of endometriosis after medical or surgical therapy? RECENT FINDINGS The review is based on recently published review papers/meta-analyses or international guidelines as published by the European Society of Human Reproduction or the American Society of Reproductive Medicine, updated with a selective review of recent papers searching PubMed with the key words 'Endometriosis', 'Assisted Reproduction', 'IVF', 'IUI' and 'Reproductive Surgery'. SUMMARY At the end of this review, a practical proposal for the clinical management of women with endometriosis-associated subfertility is proposed, based on our own experience.
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Affiliation(s)
- Annemieke De Hondt
- Department of Obstetrics and Gynaecology, Leuven University Fertility Center, University Hospital Gasthuisberg, Leuven, Belgium
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Collinet P, Decanter C, Lefebvre C, Leroy JL, Vinatier D. Endométriose et infertilité. ACTA ACUST UNITED AC 2006; 34:379-84. [PMID: 16650796 DOI: 10.1016/j.gyobfe.2006.03.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2005] [Accepted: 03/09/2006] [Indexed: 10/24/2022]
Abstract
Relationship between infertility and endometriosis is still controversial. Many mechanisms have been reported such as anatomical disorders, biologic and cytological modifications of peritoneal liquid, functional ovarian and endometrial disorders, reduced embryo quality. Management of infertility related to endometriosis is difficult and no consensus has been published yet. Following recent clinical data, therapeutic strategies are discussed.
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Affiliation(s)
- P Collinet
- Clinique de Gynécologie-Obstétrique et Néonatalogie, Hôpital Jeanne-de-Flandre, CHRU de Lille, France.
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Tomassetti C, Meuleman C, Pexsters A, Mihalyi A, Kyama C, Simsa P, D'Hooghe TM. Endometriosis, recurrent miscarriage and implantation failure: is there an immunological link? Reprod Biomed Online 2006; 13:58-64. [PMID: 16820110 DOI: 10.1016/s1472-6483(10)62016-0] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Endometriosis is more frequently diagnosed in patients with infertility than in a normal population. The goal of this paper is to give an overview of the clinical and fundamental evidence for a possible link between endometriosis and (recurrent) miscarriage or implantation failure after treatment with assisted reproductive technology. According to the literature, there is insufficient evidence for an association between endometriosis and (recurrent) miscarriage, but there is, however, epidemiological evidence to support the link between endometriosis and recurrent implantation failure after assisted reproduction. This can possibly be explained by alterations in humoral and cell-mediated immunity in women with endometriosis. Humoral immunological changes include increased formation of antibodies against endometrial antigens, anti-laminin-1 auto-antibodies and other auto-immune antibodies (e.g. antiphospholipid). Cell-mediated immunological changes include alterations in peritoneal and follicular fluid immune cells and cytokines. The possible negative effect of these immunological changes on folliculogenesis, ovulation, oocyte quality, early embryonic development and implantation in women with endometriosis suggests that infertility in endometriosis patients may be related to alterations within the follicle or oocyte, resulting in embryos with decreased ability to implant.
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Affiliation(s)
- C Tomassetti
- University Hospitals Leuven, Leuven Universitary Fertility Centre, Herestraat 49, 3000 Leuven, Belgium
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Abstract
A wealth of publications proposes that endometriosis and inflammation may have an unfavorable influence on fertility. A recent meta-analysis of assisted reproductive technologies demonstrated that, once confounding factors are controlled for, the pregnancy rate in women with endometriosis is approximately 50% of the rate of women with tubal factor infertility. Peritoneal fluid of women with endometriosis contains elevated amounts of macrophages and their secreted products, such as growth factors, cytokines, and angiogenic factors. Because reproductive organs are bathed in and thus will be influenced by peritoneal fluid, these proinflammatory mediators would affect various aspects of reproduction in women with endometriosis. Advanced stages of endometriosis may have easily understandable factors, such as distortion of the anatomy, causing infertility. On the other hand, in minimal or mild endometriosis mechanisms underlying reproductive failure are subtle and remain controversial. Recent reports suggest that inflammatory factors play a role in this endometriosis-associated reproductive failure. This review provides an overview of recent data on the effects of endometriosis-associated inflammation on fertility.
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Affiliation(s)
- Gülden Halis
- Endometriosezentrum Berlin, Department of Obstetrics and Gynecology, CBF, Charité-Universitätsmedizin, Berlin, Germany
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Pabuccu R, Onalan G, Goktolga U, Kucuk T, Orhon E, Ceyhan T. Aspiration of ovarian endometriomas before intracytoplasmic sperm injection. Fertil Steril 2004; 82:705-11. [PMID: 15374718 DOI: 10.1016/j.fertnstert.2004.02.117] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2003] [Revised: 02/02/2004] [Accepted: 02/02/2004] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To investigate whether aspiration of ovarian endometriomas before controlled ovarian stimulation (COH) improves intracytoplasmic sperm injection (ICSI) outcomes. DESIGN Prospective study. SETTING University hospital. PATIENT(S) A prospective analysis of 171 patients with ovarian endometriosis and tubal factor infertility were divided into four groups: aspiration of endometriomas at the beginning of COH in patients with ovarian endometriomas and no history of previous surgery (n = 41) (group 1); nonaspirated endometriomas (n = 40) (group 2); history of ovarian surgery for endometriomas in patients without ovarian endometriomas at the beginning of COH (n = 44) (group 3); and tubal factor infertility (n = 46) (control group 4). INTERVENTION(S) Aspiration of endometriomas. MAIN OUTCOME MEASURE(S) Clinical parameters, characteristics of COH, and ICSI results were analyzed. RESULT(S) We observed higher levels of E(2) on the day of hCG injection after aspiration of endometriomas compared with nonaspirated endometriomas. When we compared all endometriomas and tubal factor (control) groups, we observed a lower number of total follicles (>17 mm) and metaphase II (MII) oocytes in nonaspirated and resected endometrioma groups and a longer duration of COH in the nonaspirated endometrioma group compared with the tubal factor group. Implantation and clinical pregnancy rates were similar among all groups. CONCLUSION(S) In the current study, all patients with endometriomas had significantly lower numbers of MII oocytes compared with those in patients with tubal factor infertility. We propose that aspiration of endometriomas before COH neither reduces the amount of gonadotropins nor increases the number of follicles >17 mm, the number of MII oocytes retrieved, the implantation rates, or the clinical pregnancy rates. Resection of small endometriomas (1-6 cm) may not present any additional benefits to the IVF-ICSI cycle outcomes.
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Affiliation(s)
- Recai Pabuccu
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Gulhane School of Medicine, 06018 Etlik, Ankara, Turkey.
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Geber S, Ferreira DP, Spyer Prates LFV, Sales L, Sampaio M. Effects of previous ovarian surgery for endometriosis on the outcome of assisted reproduction treatment. Reprod Biomed Online 2002; 5:162-6. [PMID: 12419041 DOI: 10.1016/s1472-6483(10)61619-7] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Endometriosis affects 2-50% of women at reproductive age. Surgery is an option for treatment, but there is no convincing evidence that it promotes a significant improvement in fertility. Also, the removal of ovarian endometrioma might lead to a reduction in the follicular reserve and response to stimulation. Therefore, the aim of this study was to evaluate the effect of previous ovarian surgery for endometriosis on the ovarian response in assisted reproduction treatment cycles and its pregnancy outcome. A total of 61 women, with primary infertility and previously having undergone ovarian surgery for endometriosis, who had received 74 IVF/intracytoplasmic sperm injection (ICSI) cycles, were studied (study group). A further 74 patients with primary infertility who underwent 77 IVF/ICSI cycles within#10; the same period of time, at the same clinic and without previous ovarian surgery or endometriosis were studied as a control group. Patients were matched for age and treatment performed. Patients </=35 years with previous ovarian surgery had fewer retrieved oocytes than the patients in the control group (P = 0.049). The number of ampoules used for ovulation induction, duration of folliculogenesis; (days), number of follicles and fertilization rate was similar in both groups. The same was observed for pregnancy rates, with 24 patients (53.3%) having had previous ovarian surgery and 27 (56.2%) in the control group becoming pregnant. Patients >35 years with previous ovarian surgery needed more ampoules for ovulation induction (P = 0.017) and had fewer follicles and oocytes than women in the control group (P = 0.001). Duration of folliculogenesis was similar in both groups, as was fertilization rate. A total of 10 patients achieved pregnancy in the study group (34.5%) and 14 (48.3%) in the control group. Although a lower pregnancy rate was observed in patients who had undergone previous ovarian surgery, this difference was not statistically significant (P = 0.424). In conclusion, ovarian surgery for the treatment of endometriosis reduces the ovarian outcome in IVF/ICSI cycles in women >35 years old, and might also decrease pregnancy rates. Therefore, for infertile patients, non-surgical treatment might be a better option to avoid reduction of the ovarian response.
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Affiliation(s)
- Selmo Geber
- ORIGEN, Centro de Medicina Reprodutiva, Av. Contorno 7747, Belo Horizonte, Minas Gerais, CEP 30 010020, Brazil.
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Franco JG, Baruffi RLR. Introduction to methods for collecting human gametes in assisted reproduction. Reprod Biomed Online 2002; 5:187-97. [PMID: 12419045 DOI: 10.1016/s1472-6483(10)61623-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The first objective of IVF is the collection of oocytes and spermatozoa. This article reviews the methods of choice for each sex. Collecting oocytes involves laparoscopic puncture and ultrasonographic puncture via transabdominal/transvesical and periurethral/transvesical, transvaginal methods. Male gametes are collected by masturbation, or by aspirating spermatozoa from the epididymis or from the testicle. Sperm collections can be taken from patients with disorders of ejaculation. A brief review of each approach is presented, with a critical analysis of each method.
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Affiliation(s)
- J G Franco
- Centre for Human Reproduction Sinha Junqueira Maternity, Rua D Alberto Goncalves 1500, CEP 14085-100, Ribeirao Preto-SP, Brazil.
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Abstract
The association between endometriosis and infertility is complex. Nevertheless, in the absence of tubal distortion considerable evidence suggests four principle factors likely to contribute to subfertility. These include impaired folliculogenesis, decreased fertilization, inflammatory factors in follicular, peritoneal and reproductive tract fluid, and implantation defects. The potential impact of each of these is critically examined. The role of endometriomas, prior surgeries and donor oocytes is also discussed.
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Affiliation(s)
- Neal G Mahutte
- Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, Yale University School of Medicine, 333 Cedar Street, PO Box 208063, New Haven, CT 06520-8063, USA
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Abstract
A causal relationship between minor endometriosis and infertility or subfertility has not yet been demonstrated, although a significant association is shown by prevalence studies. This article critically reviews the evidence for pituitary-ovarian dysfunction as a cause for subfertility in women with minor endometriosis. The lack of fertile controls with endometriosis presents a methodological problem. Group comparison in studies using tubal infertility cases as controls has demonstrated impaired follicular growth, reduced circulating oestradiol concentrations during the preovulatory phase and oestradiol and progesterone during the early luteal phase, and disturbed luteinizing hormone (LH) surge patterns. LH concentration in preovulatory follicular fluid is also reduced, and granulosa cells collected at the same time have impaired steroidogenic capacity in vitro. However, these findings are not consistent in published studies. Significantly lower oocyte fertilization rates (49%) are found compared with controls (69%), even after maximum stimulation with exogenous follicle-stimulating hormone and human chorionic gonadotrophin (52% versus 69%). The implantation rate is also lower (11% versus 13%). An inherent disorder of follicular function seems likely, and LH surge impairment is probably a secondary effect. Impairment of oocyte fertilization would thus contribute substantially to the natural subfertility associated with endometriosis, but in vitro fertilization is still successful as excess numbers of oocytes are available.
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Affiliation(s)
- Johanna Trinder
- Centre for Reproductive Medicine, University of Bristol Division of Obstetrics and Gynaecology, St Michael's Hospital, Southwell Street, Bristol BS2 8EG, UK
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Rinesi L, Morente C, Botti G, Miechi H, Figueroa Casas PR, Tozzini R. Results of assisted reproductive technologies in patients with endometriosis. Fertil Steril 2002; 77:190-2. [PMID: 11779616 DOI: 10.1016/s0015-0282(01)02936-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Norenstedt SN, Linderoth-Nagy C, Bergendal A, Sjöblom P, Bergqvist A. Reduced developmental potential in oocytes from women with endometriosis. J Assist Reprod Genet 2001; 18:644-9. [PMID: 11808845 PMCID: PMC3455250 DOI: 10.1023/a:1013111200251] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To study retrospectively the outcome of intracytoplasmatic sperm injection (ICSI) in women with endometriosis compared with women with no known female infertility factor. METHODS All couples treated with ICSI because of male infertility plus verified endometriosis (n = 26) and all couples treated with ICSI because of male infertility only (n = 125) during the period January 1995 to June 1999 were included. Data were collected from patient files and ICSI protocols. RESULTS The time to complete down regulation was significantly longer (p = 0.0108), the dose of FSH significantly higher (0.0247), the day for oocyte pickup significantly later (p = 0.0091), and the cleavage rate of oocytes significantly lower (p = 0.0011) in women with endometriosis compared with controls. There was no significant difference in implantation rate or pregnancy rate between the groups. CONCLUSIONS Women with endometriosis presented significantly reduced follicular response and oocyte cleavage rate, two mechanisms that might be related to a disturbed oogenesis.
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Affiliation(s)
- Sophie Naffah Norenstedt
- Division of Clinical Sciences, Karolinska Institutet, Department of Obstetrics and Gynecology, Huddinge University Hospital, Huddinge, Sweden
| | - Christina Linderoth-Nagy
- Division of Clinical Sciences, Karolinska Institutet, Department of Obstetrics and Gynecology, Huddinge University Hospital, Huddinge, Sweden
| | - Annica Bergendal
- Division of Clinical Sciences, Karolinska Institutet, Department of Obstetrics and Gynecology, Huddinge University Hospital, Huddinge, Sweden
| | - Peter Sjöblom
- Division of Clinical Sciences, Karolinska Institutet, Department of Obstetrics and Gynecology, Huddinge University Hospital, Huddinge, Sweden
- ART System Resources PTI Ltd, PO BOX 6233, Melbourne, 3004 Australia
| | - Agneta Bergqvist
- Division of Clinical Sciences, Karolinska Institutet, Department of Obstetrics and Gynecology, Huddinge University Hospital, Huddinge, Sweden
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17
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Bukulmez O, Yarali H, Gurgan T. The presence and extent of endometriosis do not effect clinical pregnancy and implantation rates in patients undergoing intracytoplasmic sperm injection. Eur J Obstet Gynecol Reprod Biol 2001; 96:102-7. [PMID: 11311770 DOI: 10.1016/s0301-2115(00)00379-1] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess the impact of endometriosis on the outcome of intracytoplasmic sperm injection (ICSI) outcome. STUDY DESIGN Retrospective case-control study which enrolled 1280 consecutive cycles of 834 couples of ICSI with ejaculated sperm. Among them, 973 cycles of 632 couples had resulted in embryo transfer (ET). The presence of endometriosis was noted in 110 consecutive cycles of 45 patients among which 78 cycles of 44 patients had resulted in ET. Data from endometriosis group were analyzed in subgroups of minimal-mild (49 ET cycles of 25 patients) and moderate-severe (29 ET cycles of 19 patients). The controls consisted of 1170 consecutive cycles of age-matched 771 couples. Of the controls, 588 couples had 895 cycles of ET. Main outcome measures were implantation and clinical pregnancy rates. RESULTS There were no differences in cycle and ET cancellation rates between control and endometriosis groups. The number of oocytes retrieved, fertilization and cleavage rates and the number and quality of embryos developed and transferred were similar among the groups. The implantation and clinical pregnancy rates were also comparable. CONCLUSION The presence and extent of endometriosis do not affect implantation and clinical pregnancy rates in patients undergoing ICSI.
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Affiliation(s)
- O Bukulmez
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Hacettepe University School of Medicine, Ankara, Turkey.
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18
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el Amrani R, Henry-Suchet J, Cornier E, Sarjdine K, Mayenga JM, Loysel T, Belaisch-Allart J. [Comparison of 2 therapeutic strategies in severe endometriosis, in young women consulting for sterility or pain. II. In the case of infertility, value of ovarian stimulation with intrauterine insemination after surgery]. GYNECOLOGIE, OBSTETRIQUE & FERTILITE 2001; 29:192-9. [PMID: 11300044 DOI: 10.1016/s1297-9589(00)00074-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM OF THE STUDY Define the best medico surgical strategy in infertile women with stage III-IV endometriosis. MATERIAL AND METHODS Two groups, A (N26) and B (N 37), treated for infertility associated or not with pelvic pain, due to stage AFS III or IV endometriosis, were compared. They had similar surgical procedure: operative laparoscopy including resection of endometriotic lesions, more particularly endometriomas and rectovaginal septum nodules. Associated medical strategy was different: group A, operative laparoscopy without preoperative treatment and in 40% a second laparoscopy taking place after 2-3 months of LHRH analogues; no post operative treatment; group B, operative laparoscopy taking place after ovarian blockage with 3-6 weeks of Diane (Androcur + ethinyl estradiol), then 2-3 months of analogue postoperative treatment immediately followed by ovarian stimulation (OS) + intrauterine insemination (IUI) in women more than 30 years old with operative tubes (N 22), no treatment for six months in similar cases less than 30 (N 5), and IVF in women with damaged tubes (N 5) or after OS + IUI failure (N 4). One patient refused two patients with high FSH level had oocyte donation. RESULTS Two years evolutive pregnancy rate was significantly higher (p < 0.01) in group B (59%) versus group A (23%) and was higher after OS + IUI (68%) than after IVF (55%) or without any treatment in women < 30 (43%). The difference is equally significant by age (p < 0.05), for endometriomas (p < 0.01) and for recurrences (p < 0.01). CONCLUSION Similar results obtained for pelvic pain (see chapter I) suggest that both strategies are similarly successful in treating endometriosis. These results confirm the interest of an ART after surgery for stage III-IV endometriosis and show that OS + IUI, a less costly than IVF technique, can be used successfully in selected cases with operative tubes.
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Affiliation(s)
- R el Amrani
- Service de gynécologie-obstétrique et reproduction humaine, hôpital Jean-Rostand, 141, Grande Rue, 92311, Sèvres, France
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Abstract
The association between endometriosis and infertility is well established, and different mechanisms have been postulated to cause infertility depending on the stage of endometriosis. Controlled ovarian hyperstimulation improves pregnancy outcome for minimal to mild endometriosis; however, there are no randomized controlled studies of this technique in patients with severe disease. Further, ART appears to have an overall beneficial effect for all stages of endometriosis. Based on the current staging system, several studies have not been able to demonstrate a significant difference in true outcomes for different stages of the disease. The limitations of these studies have been discussed above. Similarly, the effect of endometriomas when considered independent of the stage is still unclear. In addition to ART, pretreatment with GnRH analogues or surgical intervention may be beneficial and needs to be addressed in randomized controlled studies. It is evident that we urgently need large randomized studies to answer several questions about the treatment of endometriosis-associated infertility with ART. Although our current practice is based primarily on retrospective observational studies and small randomized studies, the overall impact on pregnancy outcome is beneficial.
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Affiliation(s)
- A Dokras
- Department of Obstetrics and Gynecology, Yale University School of Medicine, New Haven, CT 06510, USA
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