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Mathyk BA, Cetin E, Youssef Y, Imudia AN, Encalada Soto D, Mikhail E, Moawad G. Beyond the surface: Does stage I-II endometriosis impact fertility? Exploring the challenges of mild disease. Best Pract Res Clin Obstet Gynaecol 2024:102501. [PMID: 38760260 DOI: 10.1016/j.bpobgyn.2024.102501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 04/21/2024] [Accepted: 05/02/2024] [Indexed: 05/19/2024]
Abstract
Endometriosis is one of the most common gynecologic conditions that women face throughout their lives. Despite advances in technology, diagnosis and treatment of this relapsing and remitting condition is still challenging for many women. This review focuses on literature pertaining to minimal/mild (stage I/II) endometriosis and its impact on fertility. The effectiveness of medical interventions to improve infertility and obstetric outcomes in both natural and assisted reproductive technologies cycles remains debated. The recent ESHRE guidelines suggests that operative laparoscopy could be considered for rASRM stage I/II endometriosis as it improves ongoing pregnancy rates.
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Affiliation(s)
- Begum Aydogan Mathyk
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of South Florida Morsani College of Medicine, Tampa, FL, USA.
| | - Esra Cetin
- Department of Obstetrics and Gynecology, Hurley Medical Center, Michigan State University, 1 Hurley Plaza, Flint, MI, 48503, USA
| | - Youssef Youssef
- Division of Minimally Invasive Gynecology, Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, NY, 11220, USA
| | - Anthony N Imudia
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Diana Encalada Soto
- Division of Gynecologic Subspecialties, Department of Obstetrics and Gynecology, University of South Florida, Morsani College of Medicine, Tampa, FL, USA
| | - Emad Mikhail
- Division of Gynecologic Subspecialties, Department of Obstetrics and Gynecology, University of South Florida, Morsani College of Medicine, Tampa, FL, USA
| | - Gaby Moawad
- Department of Obstetrics and Gynecology, George Washington University, Washington, DC, 20037, USA; The Center for Endometriosis and Advanced Pelvic Surgery, Washington, DC, 22101, USA
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Alson S, Henic E, Jokubkiene L, Sladkevicius P. Endometriosis diagnosed by ultrasound is associated with lower live birth rates in women undergoing their first in vitro fertilization/intracytoplasmic sperm injection treatment. Fertil Steril 2024; 121:832-841. [PMID: 38246403 DOI: 10.1016/j.fertnstert.2024.01.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 01/09/2024] [Accepted: 01/15/2024] [Indexed: 01/23/2024]
Abstract
OBJECTIVE To study the cumulative live birth rate (CLBR) after the first in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) treatment in women with or without deep-infiltrating endometriosis (DIE) and/or endometrioma diagnosed by transvaginal ultrasonography (TVUS), using the International Deep Endometriosis Analysis (IDEA) group definitions. DESIGN Prospective observational cohort study at a university hospital. PATIENTS(S) In total, 1,040 women with subfertility aged 25 to ≤39 years were undergoing their first IVF/ICSI treatment between January 2019 and October 2022. Of these, 234 (22.5%; 95% confidence interval [CI], 20.0-25.0) women were diagnosed with DIE and/or endometrioma at systematic TVUS before starting their treatment. INTERVENTION(S) All women underwent their first IVF or ICSI treatment. Fresh and/or frozen embryos from the first cycle were used until pregnancy was achieved or no embryos remained. MAIN OUTCOME MEASURE(S) Cumulative live birth rate after the first IVF/ICSI cycle in women with or without DIE and/or endometrioma. RESULT(S) The CLBR after the first IVF/ICSI treatment in the total cohort of women was 426/1,040 (41.0%; 95% CI, 38.0-44.0). Women with DIE and/or endometrioma had a lower CLBR (78/234, 33.3%; 95% CI, 27.3-39.4) than women without the disease (348/806, 43.2%; 95% CI, 39.8-46.6). The crude relative risk (RR) for cumulative live birth for women with DIE and/or endometrioma was 0.77; 95% CI, 0.63-0.94, and after adjustments were made for age, body mass index, s-antimüllerian hormone, stimulation protocol, and day for embryo transfer, the adjusted RR was 0.63; 95% CI, 0.48-0.82. There was no difference in the number of retrieved mature oocytes, fertilization rate, or good quality embryos between the 2 groups. CONCLUSION The presence of DIE and/or endometrioma diagnosed by TVUS lowers the chance of live birth in women undergoing their first IVF/ICSI treatment.
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Affiliation(s)
- Sara Alson
- Obstetric, Gynecological and Prenatal Ultrasound research, Department of Clinical Sciences, Malmö, Lund University, Sweden; Department of Obstetrics and Gynecology, Skåne University Hospital, Malmö, Sweden; Reproductive Medicine Center, Skåne University Hospital, Malmö, Sweden.
| | - Emir Henic
- Reproductive Medicine Center, Skåne University Hospital, Malmö, Sweden; Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Ligita Jokubkiene
- Obstetric, Gynecological and Prenatal Ultrasound research, Department of Clinical Sciences, Malmö, Lund University, Sweden; Department of Obstetrics and Gynecology, Skåne University Hospital, Malmö, Sweden
| | - Povilas Sladkevicius
- Obstetric, Gynecological and Prenatal Ultrasound research, Department of Clinical Sciences, Malmö, Lund University, Sweden; Department of Obstetrics and Gynecology, Skåne University Hospital, Malmö, Sweden
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Lessans N, Gilan A, Dick A, Bibar N, Saar TD, Porat S, Dior UP. Ovarian reserve markers of women with superficial endometriosis. Int J Gynaecol Obstet 2024; 165:696-702. [PMID: 38124348 DOI: 10.1002/ijgo.15310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 11/28/2023] [Accepted: 12/04/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVE Endometriosis affects up to 10% of reproductive age women and is associated with pelvic pain and subfertility. While previous studies have shown an association between deep and ovarian endometriosis to reduced ovarian reserve, there is no data on the effect of superficial endometriosis on ovarian reserve markers. Hence, we aimed to compare ovarian reserve markers of women with superficial endometriosis to that of women without endometriosis. METHODS This was a case control study in a tertiary medical center. The study group included women aged 18-40 with surgically and histopathology-proven superficial endometriosis with no deep lesions or ovarian involvement. The control group included women with no known or suspected endometriosis and was matched to the study group by age, BMI and parity. We excluded women with other known risk factors for ovarian failure and with other gynecological disorders. Participants completed a questionnaire with demographic, medical and gynecological data. Each patient underwent anti-Mullerian hormone (AMH) testing and an ultrasound to assess their antral follicular count (AFC). AMH and AFC were then compared between groups. RESULTS A total of 124 women participated in the study. Of these, 50% (n = 62) had surgically proven superficial endometriosis and 50% (n = 62) were without known or suspected endometriosis. Mean AMH levels of women with and without superficial endometriosis was 3.0 ± 2.8 ng/mL and 2.8 ± 1.9 ng/mL, respectively (P = 0.71). AFC also did not differ between groups (women with superficial endometriosis: 12.0 ± 6.6; women without endometriosis: 10.2 ± 5.0, P = 0.15). CONCLUSIONS In our cohort, superficial endometriosis was not associated with diminished ovarian reserve. While further studies are needed, to date, it does not appear to be justified to assess ovarian reserve for patients with superficial endometriosis.
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Affiliation(s)
- Naama Lessans
- Endometriosis Center, Department of Obstetrics and Gynecology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Adi Gilan
- Endometriosis Center, Department of Obstetrics and Gynecology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Aharon Dick
- Endometriosis Center, Department of Obstetrics and Gynecology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Natalie Bibar
- Endometriosis Center, Department of Obstetrics and Gynecology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Tal D Saar
- Endometriosis Center, Department of Obstetrics and Gynecology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Shay Porat
- Endometriosis Center, Department of Obstetrics and Gynecology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Uri P Dior
- Endometriosis Center, Department of Obstetrics and Gynecology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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Racca A, Bernabeu A, Bernabeu R, Ferrero S. Endometrial receptivity in women with endometriosis. Best Pract Res Clin Obstet Gynaecol 2024; 92:102438. [PMID: 38183768 DOI: 10.1016/j.bpobgyn.2023.102438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 11/21/2023] [Indexed: 01/08/2024]
Abstract
As endometriosis is recognized as a contributing factor to infertility, prompting couples to embark on Assisted Reproductive Technology (ART) treatments, it becomes crucial to comprehend the extent and way this condition can affect success rates. Natural conception data reveal lower success rates for women with endometriosis, yet the same cannot be extrapolated to the outcomes of in vitro fertilization (IVF). In recent years, advancements in the ART process, particularly the distinct stages of the IVF pathway and investigations into embryo quality have shown a comparable rate of embryonic quality and chromosomal normalcy (euploidy) between embryos obtained from individuals with or without endometriosis. Thus, the primary question that lingers relates to the functionality of the endometrium. This review addresses whether endometriosis can influence endometrial receptivity and implantation rates.
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Affiliation(s)
| | | | | | - Simone Ferrero
- IRCCS Ospedale Policlinico San Martino, Genova, Italy; DINOGMI, University of Genova, Italy
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Bartolacci A, dell'Aquila M, Coticchio G, Intra G, Parodi F, Patria G, Zacà C, Borini A. Endometriosis affects the number of retrieved oocytes but not early embryonic development and live birth: a retrospective analysis of 716 IVF cycles. HUM FERTIL 2023; 26:1469-1476. [PMID: 37139851 DOI: 10.1080/14647273.2023.2200979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 01/27/2023] [Indexed: 05/05/2023]
Abstract
To investigate the potential effect of endometriosis on embryo development and clinical outcomes, a retrospective analysis of 716 women undergoing their first standard in vitro fertilization (sIVF) cycles (205 endometriosis and 511 with tubal factor infertility) was performed. The endometriosis group included women with an ultrasonographic or surgical diagnosis. Control subjects were women diagnosed with tubal factor infertility by laparoscopy or hysterosalpingogram. The primary outcome of the study was live birth. Cumulative live birth was also assessed in a subgroups analysis. After adjusting for confounders we found no significant difference in fertilization rate, blastulation, top-quality blastocyst, live birth, cumulative live birth (subgroups analysis) and miscarriage rate. In the endometriosis group, the number of retrieved oocytes was smaller (6.94 ± 4.06 Vs 7.50 ± 4.6, adjusted p < 0.05). We observed a statistically significant difference in the percentage of day-3 embryos with ≥8 blastomeres (33.12 ± 22.72 endometriosis vs, 40.77 ± 27.62 tubal factor, adjusted p < 0.01) and a negative correlation between the presence of endometriomas and a number of retrieved oocytes [B coefficient =-1.41, 95%CI (-2.31-0.51), adjusted p = 0.002]. Our results suggest that endometriosis affects the number of retrieved oocytes but not embryo development and live birth.
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Endometriosis and Infertility: A Long-Life Approach to Preserve Reproductive Integrity. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19106162. [PMID: 35627698 PMCID: PMC9141878 DOI: 10.3390/ijerph19106162] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 05/01/2022] [Accepted: 05/06/2022] [Indexed: 02/04/2023]
Abstract
Laparoscopic surgery was originally considered the gold standard in the treatment of endometriosis-related infertility. Assisted reproductive technology (ART) was indicated as second-line treatment or in the case of male factor. The combined approach of surgery followed by ART proved to offer higher chances of pregnancy in infertile women with endometriosis. However, it was highlighted how pelvic surgery for endometriosis, especially in cases of ovarian endometriomas, could cause iatrogenic damage due to ovarian reserve loss, adhesion formation (scarring), and ischemic damage. Furthermore, in the last few years, the trend to delay the first childbirth, recent technological advances in ultrasound diagnosis, and technological progress in clinical and laboratory aspects of ART have certainly influenced the approach to infertility and endometriosis with, ART assuming a more relevant role. Management of endometriosis should take into account that the disease is chronic and involves the reproductive system. Consequently, treatment and counselling should aim to preserve the chances of pregnancy for the patient, even if it is not associated with infertility. This review will analyse the evolution of the management of infertility associated with endometriosis and propose an algorithm for treatment decision-making based on the most recent acquisitions.
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Younis JS. Is Oocyte Quality Impaired in Cases With Ovarian Endometriosis? A Second Look Into the Clinical Setting. Front Endocrinol (Lausanne) 2022; 13:921032. [PMID: 35846314 PMCID: PMC9279608 DOI: 10.3389/fendo.2022.921032] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 06/06/2022] [Indexed: 11/24/2022] Open
Affiliation(s)
- Johnny S. Younis
- Reproductive Medicine, Department of Obstetrics and Gynecology, Baruch-Padeh Medical Center, Poriya, Israel
- Azrieili Faculty of Medicine in Galilee, Safed, Bar-Ilan University, Safed, Israel
- *Correspondence: Johnny S. Younis,
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Mooney SS, Ross V, Stern C, Rogers PAW, Healey M. Obstetric Outcome After Surgical Treatment of Endometriosis: A Review of the Literature. FRONTIERS IN REPRODUCTIVE HEALTH 2021; 3:750750. [DOI: 10.3389/frph.2021.750750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 11/23/2021] [Indexed: 11/13/2022] Open
Abstract
A diagnosis of endometriosis is associated with increased risks of adverse pregnancy outcomes including placenta praevia and preterm birth. Some studies have also suggested associations with gestational hypertension, foetal growth restriction, gestational diabetes, perinatal death, and obstetric haemorrhage. This review aims to assess the impact of pre-pregnancy surgical treatment of endometriosis on future obstetric outcomes. A search of the Medline, Embase and PubMed electronic databases was performed to identify studies reporting pre-pregnancy surgery for endometriosis and subsequent pregnancy outcome compared to controls with unresected endometriosis. Three studies met the inclusion criteria. The studies were heterogenous in design, definition of study groups and outcome measures. All three studies were judged at critical risk of bias. Pre-pregnancy excision of endometriosis was associated with an increased risk of caesarean section in one of two studies, OR 1.72 (95% CI 1.59–1.86) and OR 1.79 (95% CI 0.69–4.64). Placenta praevia rates were also increased in one of two studies OR 2.83 (95% CI 0.56–12.31) and OR 2.04 (95% CI 1.66–2.52). One study found increased risks of preterm birth, small for gestational age, gestational hypertension, and antepartum and postpartum haemorrhage (all p < 0.05) with pre-pregnancy excision of endometriosis. There is insufficient evidence examining the role of pre-pregnancy endometriosis surgery in ameliorating adverse pregnancy outcomes, and thus reliable conclusions cannot be drawn. Prospectively designed studies are needed to assess the relationship between surgical treatments for endometriosis and obstetric outcome and examine potential confounders such as comorbid adenomyosis and infertility.
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Caran J, Genro VK, Souza CABD, Cunha-Filho JS. The Graduated Embryo Score of Embryos from Infertile Women with and without Peritoneal Endometriosis. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2021; 43:28-34. [PMID: 33513633 PMCID: PMC10183902 DOI: 10.1055/s-0040-1721855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVE To determine embryo quality (mean graduated embryo score [GES]) in infertile patients with endometriosis undergoing in vitro fertilization with embryo transfer (IVF-ET) compared with infertile patients without endometriosis. METHODS A case-control study was performed comparing 706 embryos (162 patients) divided into 2 groups: 472 embryos derived from patients without endometriosis (n = 109, infertile patients with tubal infertility) and 234 embryos from patients in the study group (n = 53, infertile patients with peritoneal endometriosis). All patients were subjected to IVF using an oestradiol-antagonist-recombinant follicle-stimulating hormone (FSH) protocol for ovarian stimulation. The mean GES was performed to evaluate all embryos at 3 points in time: 16 to 18 hours, 25 to 27 hours, and 64 to 67 hours. Embryo evaluation was performed according to the following parameters: fragmentation, nucleolar alignment, polar body apposition, blastomere number/morphology, and symmetry. The primary outcome measure was the mean GES score. We also compared fertilization, implantation, and pregnancy rates. RESULTS Although the number of embryos transferred was greater in patients with endometriosis than in the control group (2.38 ± 0.66 versus 2.15 ± 0.54; p = 0.001), the mean GES was similar in both groups (71 ± 19.8 versus 71.9 ± 23.5; p = 0.881). Likewise, the fertilization rate was similar in all groups, being 61% in patients with endometriosis and 59% in the control group (p = 0.511). No significant differences were observed in the implantation (21% versus 22%; [p = 0.989]) and pregnancy rates (26.4% versus 28.4%; p = 0.989). CONCLUSION Embryo quality measured by the mean GES was not influenced by peritoneal endometriosis. Likewise, the evaluated reproductive outcomes were similar between infertile patients with and without endometriosis.
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Affiliation(s)
- Juliana Caran
- Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Vanessa Krebs Genro
- Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.,Department of Obstetrics and Gynecology, Centro de Reprodução Humana Insemine, Porto Alegre, RS, Brazil
| | | | - João Sabino Cunha-Filho
- Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.,Department of Obstetrics and Gynecology, Centro de Reprodução Humana Insemine, Porto Alegre, RS, Brazil
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Zhong C, Gao L, Shu L, Hou Z, Cai L, Huang J, Liu J, Mao Y. Analysis of IVF/ICSI Outcomes in Endometriosis Patients With Recurrent Implantation Failure: Influence on Cumulative Live Birth Rate. Front Endocrinol (Lausanne) 2021; 12:640288. [PMID: 34393990 PMCID: PMC8362597 DOI: 10.3389/fendo.2021.640288] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 07/19/2021] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To study the influence of endometriosis activity on the pregnancy outcomes of patients with recurrent implantation failure (RIF) in in-vitro fertilization/intra-cytoplasmic sperm injection (IVF/ICSI) cycles. The pregnancy outcomes were compared between RIF patients with endometriosis who received treatment at different occasions to explore the appropriate treatment plan for these patients and to optimize the pregnancy-support strategies. DESIGN Ambispective cohort study. METHODS A total of 330 patients with endometriosis were enrolled from 2008 to 2018 and included 1043 IVF/ICSI cycles. All patients were diagnosed with RIF after IVF/ICSI. Patients were assigned to three subtypes according to different control states of endometriosis, including the untreated, early-treatment, and late-treatment groups. The clinical pregnancy rate, live birth rate, and cumulative live birth rate of endometriosis patients with RIF were the main outcomes; additionally, the fertilization rate, available embryonic rate, and high-quality embryonic rate were also compared. RESULTS The early-treatment and late-treatment groups showed higher cumulative live birth rate than the untreated group (early-treated 43.6% vs. late-treated 46.3% vs. untreated 27.7%, P<0.001), though patients in the two treatment groups had higher rates of adenomyosis and ovarian surgery. The two treatment group showed a better laboratory result than the untreated and especially, the early-treatment group. The untreated group (46.24%) had a lower IVF fertilization rate than the treated group (early-treated [64.40%] and late-treated [60.27%] (P<0.001). In addition, the rates of available embryos and high-quality embryos in the early-treated group were much higher those that in the untreated group (90.30% vs. 85.20%, 76.50% vs. 64.47%). Kaplan-Meier curve showed that patients in the untreated group needed a mean of 23.126 months to achieve one live birth; whereas those in the treated group needed a comparatively shorter duration (early-treated: 18.479 ± 0.882 months and late-treated: 14.183 ± 1.102 months, respectively). CONCLUSION Endometriosis has a negative influence on IVF/ICSI outcome. The control of endometriosis activity can result in a higher cumulative live birth rate in patients. It is necessary for endometriosis patients to receive medical treatment to achieve a better prognosis especially for those with RIF.
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Affiliation(s)
- Chenyi Zhong
- State Key Laboratory of Reproductive Medicine, Center of Clinic Reproductive Medicine, The First Affiliated Hospital of Nanjing Medical University/Jiangsu Province Hospital/Jiangsu Women and Children Health Hospital, Nanjing, China
| | - Liusijie Gao
- State Key Laboratory of Reproductive Medicine, Center of Clinic Reproductive Medicine, The First Affiliated Hospital of Nanjing Medical University/Jiangsu Province Hospital/Jiangsu Women and Children Health Hospital, Nanjing, China
- OB/GYN Department, The Second Affiliated Hospital of Nantong University, Nantong, China
| | - Li Shu
- State Key Laboratory of Reproductive Medicine, Center of Clinic Reproductive Medicine, The First Affiliated Hospital of Nanjing Medical University/Jiangsu Province Hospital/Jiangsu Women and Children Health Hospital, Nanjing, China
| | - Zhen Hou
- State Key Laboratory of Reproductive Medicine, Center of Clinic Reproductive Medicine, The First Affiliated Hospital of Nanjing Medical University/Jiangsu Province Hospital/Jiangsu Women and Children Health Hospital, Nanjing, China
| | - Lingbo Cai
- State Key Laboratory of Reproductive Medicine, Center of Clinic Reproductive Medicine, The First Affiliated Hospital of Nanjing Medical University/Jiangsu Province Hospital/Jiangsu Women and Children Health Hospital, Nanjing, China
| | - Jie Huang
- State Key Laboratory of Reproductive Medicine, Center of Clinic Reproductive Medicine, The First Affiliated Hospital of Nanjing Medical University/Jiangsu Province Hospital/Jiangsu Women and Children Health Hospital, Nanjing, China
| | - Jiayin Liu
- State Key Laboratory of Reproductive Medicine, Center of Clinic Reproductive Medicine, The First Affiliated Hospital of Nanjing Medical University/Jiangsu Province Hospital/Jiangsu Women and Children Health Hospital, Nanjing, China
| | - Yundong Mao
- State Key Laboratory of Reproductive Medicine, Center of Clinic Reproductive Medicine, The First Affiliated Hospital of Nanjing Medical University/Jiangsu Province Hospital/Jiangsu Women and Children Health Hospital, Nanjing, China
- *Correspondence: Yundong Mao,
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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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Endometriosis Lowers the Cumulative Live Birth Rates in IVF by Decreasing the Number of Embryos but Not Their Quality. J Clin Med 2020; 9:jcm9082478. [PMID: 32752267 PMCID: PMC7464781 DOI: 10.3390/jcm9082478] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 07/24/2020] [Accepted: 07/28/2020] [Indexed: 12/11/2022] Open
Abstract
Endometriosis and infertility are closely linked, but the underlying mechanisms are still poorly understood. This study aimed to evaluate the impact of endometriosis on in vitro fertilization (IVF) parameters, especially on embryo quality and IVF outcomes. A total of 1124 cycles with intracytoplasmic sperm injection were retrospectively evaluated, including 155 cycles with endometriosis and 969 cycles without endometriosis. Women with endometriosis had significantly lower ovarian reserve markers (AMH and AFC), regardless of previous ovarian surgery. Despite receiving significantly higher doses of exogenous gonadotropins, they had significantly fewer oocytes, mature oocytes, embryos, and top-quality embryos than women in the control group. Multivariate analysis did not reveal any association between endometriosis and the proportion of top-quality embryo (OR = 0.87; 95% CI [0.66-1.12]; p = 0.3). The implantation rate and the live birth rate per cycle were comparable between the two groups (p = 0.05), but the cumulative live births rate was significantly lower in in the endometriosis group (32.1% versus 50.7%, p = 0.001), as a consequence of the lower number of frozen embryos. In conclusion, endometriosis lowers the cumulative live birth rates by decreasing the number of embryos available to transfer, but not their quality.
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13
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Horton J, Sterrenburg M, Lane S, Maheshwari A, Li TC, Cheong Y. Reproductive, obstetric, and perinatal outcomes of women with adenomyosis and endometriosis: a systematic review and meta-analysis. Hum Reprod Update 2020; 25:592-632. [PMID: 31318420 DOI: 10.1093/humupd/dmz012] [Citation(s) in RCA: 159] [Impact Index Per Article: 39.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 01/02/2019] [Accepted: 02/08/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The reproductive impact of adenomyosis and endometriosis is widely researched but the extent of these impacts remains elusive. It has been demonstrated that endometriosis, in particular, is known to result in subfertility but endometriosis and adenomyosis are increasingly linked to late pregnancy complications such as those caused by placental insufficiency. At the molecular level, the presence of ectopic endometrium perturbs the endometrial hormonal, cellular, and immunological milieu, negatively influencing decidualization, placentation, and developmental programming of the embryo. It is unclear if and how such early aberrant reproductive development relates to pregnancy outcomes in endometriosis and adenomyosis. OBJECTIVE AND RATIONALE The aims of this systematic review and meta-analysis were to (i) investigate the association of adenomyosis and endometriosis with fertility, obstetric, and neonatal outcomes of women through both assisted reproduction and natural conception and (ii) determine whether endometriosis disease subtypes have specific impacts on different stages of the reproductive process. SEARCH METHODS A systematic literature review of NHS evidence electronic databases and the Cochrane database identified all comparative and observational studies between 1980 and December 2018 in any language on adenomyosis and endometriosis with fertility, obstetric, and neonatal outcomes (23 search terms used). A total of 104 papers were selected for data extraction and meta-analysis, with use of Downs and Black standardized checklist to evaluate quality and bias. OUTCOMES We found that endometriosis consistently leads to reduced oocyte yield and a reduced fertilization rate (FR), in line with current evidence. Milder forms of endometriosis were most likely to affect the fertilization (FR OR 0.77, CI 0.63-0.93) and earlier implantation processes (implantation rate OR 0.76, CI 0.62-0.93). The more severe disease by American Society for Reproductive Medicine staging (ASRM III and IV) influenced all stages of reproduction. Ovarian endometriosis negatively affects the oocyte yield (MD -1.22, CI -1.96, -0.49) and number of mature oocytes (MD -2.24, CI -3.4, -1.09). We found an increased risk of miscarriage in both adenomyosis and endometriosis (OR 3.40, CI 1.41-8.65 and OR 1.30, CI 1.25-1.35, respectively), and endometriosis can be associated with a range of obstetric and fetal complications including preterm delivery (OR 1.38, CI 1.01-1.89), caesarean section delivery (OR 1.98 CI 1.64-2.38), and neonatal unit admission following delivery (OR 1.29, CI 1.07-1.55). WIDER IMPLICATIONS Adenomyosis and the subtypes of endometriosis may have specific complication profiles though further evidence is needed to be able to draw conclusions. Several known pregnancy complications are likely to be associated with these conditions. The complications are possibly caused by dysfunctional uterine changes leading to implantation and placentation issues and therefore could potentially have far-reaching consequences as suggested by Barker's hypothesis. Our findings would suggest that women with these conditions should ideally receive pre-natal counselling and should be considered higher risk in pregnancy and at delivery, until evidence to the contrary is available. In order to expand our knowledge of these conditions and better advise on future management of these patients in reproductive and maternal medicine, a more unified approach to studying fertility and reproductive outcomes with longer term follow-up of the offspring and attention to the subtype of disease is necessary.
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Affiliation(s)
- Joanne Horton
- University of Southampton, Human Development and Health, Southampton, UK.,University of Southampton, Complete Fertility, Princess Anne Hospital, Southampton, UK
| | - Monique Sterrenburg
- University of Sheffield, Academic Unit of Medical, Sheffield, UK.,University of Sheffield, Sheffield Teaching Hospitals NHS Foundation Trust, Obstetrics and Gynaecology, Sheffield, UK
| | - Simon Lane
- University of Southampton, Institute for Life Sciences, Southampton, UK
| | - Abha Maheshwari
- University of Aberdeen, Obstetrics and Gynaecology, Aberdeen, UK
| | - Tin Chiu Li
- Chinese University of Hong Kong, Department of Obstetrics and Gynaecology, Shatin, Hong Kong
| | - Ying Cheong
- University of Southampton, Human Development and Health, Southampton, UK.,University of Southampton, Complete Fertility, Princess Anne Hospital, Southampton, UK
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14
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Mitochondrial Function in Modulating Human Granulosa Cell Steroidogenesis and Female Fertility. Int J Mol Sci 2020; 21:ijms21103592. [PMID: 32438750 PMCID: PMC7279321 DOI: 10.3390/ijms21103592] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 05/04/2020] [Accepted: 05/18/2020] [Indexed: 02/07/2023] Open
Abstract
Ovarian follicle steroidogenesis associated with embryo quality results in a successful pregnancy. Each follicle consists of an oocyte surrounded by granulosa cells, which secrete several steroid and peptide hormones. Follicles harvested from women who conceived after assisted reproductive therapy (ART) had significantly higher estradiol levels in follicular fluids than the follicles from women who failed to conceive after ART. The higher follicular estradiol levels correlate well with successful fertilization following ART. Mitochondria are the central sites for steroid hormone biosynthesis. The first and rate-limiting step in the biosynthesis of steroid hormones occurs in the mitochondria of granulosa cells. In the present study, we hypothesized that the mitochondria in granulosa cells are critical for maintaining oocyte quality and fertility capacity. This study aims to clarify the relationship between mitochondrial function and granulosa cell steroidogenesis, and the relationship between hormone levels and fertility capacity. Sera, follicular fluids and granulosa cells were obtained from individuals undergoing IVF-ET treatment. The oocyte numbers, oocyte quality, fertilization rate, and pregnancy rate were also recorded. The patients who provided the granulosa cells were further classified into four groups: endometriosis, ovarian endometrioma, endometriosis without ovarian endometrioma, and polycystic ovary syndrome (PCOS); patients with other female factor infertility and male factor infertility were used as controls. We measured the levels of estradiol (E2) by radioimmunoassay. Concurrently, we analyzed the mitochondrial mass and membrane potential, and apoptosis by flow cytometry using nonyl acridine orange, TMRE, Annexin V-FITC and PI. Mitochondrial morphology was visualized by transfection with pLV-mitoDsRed. In addition, we assessed the protein levels of steroidogenic enzymes, steroidogenic acute regulatory protein (StAR) and 3β-hydroxysteroid dehydrogenase (3β-HSD) by Western blot. The results showed significantly decreased serum E2 and follicular E2 levels, and decreased IVF outcomes, in the patients with endometriosis. Reduced mitochondrial mass and decreased mitochondrial membrane potential were correlated with lower E2. Furthermore, a significant decrease in StAR and 3β-HSD was found in patients with ovarian endometrioma. The enzyme levels of StAR and 3β-HSD were highly correlated with E2 levels. Finally, elevated cumulus cell apoptosis was found in the patient group with ovarian endometrioma and PCOS. In conclusion, mitochondrial dysfunction of human granulosa cells may contribute to the decline of steroidogenesis, decreased fertilization rate, oocyte maturation rate, and oocyte quality, and it can ultimately jeopardize fertility.
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15
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González-Foruria I, Soldevila PB, Rodríguez I, Rodríguez-Purata J, Pardos C, García S, Pascual MÁ, Barri PN, Polyzos NP. Do ovarian endometriomas affect ovarian response to ovarian stimulation for IVF/ICSI? Reprod Biomed Online 2020; 41:37-43. [PMID: 32456967 DOI: 10.1016/j.rbmo.2020.03.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 03/10/2020] [Accepted: 03/20/2020] [Indexed: 12/18/2022]
Abstract
RESEARCH QUESTION Does the presence of ovarian endometriomas affect ovarian response to ovarian stimulation after adjusting for age and ovarian reserve markers? DESIGN This retrospective cross-sectional study compared the ovarian response between patients with ovarian endometriomas and women with other infertility factors undergoing their first ovarian stimulation for IVF/intracytoplasmic sperm injection (ICSI). An age-specific nomogram model for the number of oocytes retrieved was built for both groups, and ovarian response was compared after adjusting for age, gonadotrophin dose, anti-Mullerian hormone (AMH) concentration and antral follicle count (AFC). RESULTS A total of 923 patients were included: 101 women with at least one ovarian endometrioma, and 822 patients with other infertility factors. Comparisons of the nomograms for the number of oocytes retrieved demonstrated that response was significantly lower for women with endometrioma when the results were adjusted for age the z-score for the number of oocytes retrieved (-0.49 ± 0.71 versus -0.20 ± 0.86; 95% confidence interval [CI] -0.47 to -0.12) and also after adjustment for the total dose of gonadotrophins and AMH values (z-score mean difference -0.338; 95% CI -0.54, -0.14). When the z-score was adjusted for gonadotrophin dose and AFC, the number of oocytes retrieved was comparable between the two groups (z-score mean difference -0.038; 95% CI -0.34 to 0.27). CONCLUSIONS Ovarian response after ovarian stimulation for IVF/ICSI in women with endometriomas is significantly lower than in controls after adjusting for age, gonadotrophin dose and AMH. Dose and protocol selection for ovarian stimulation in patients with endometrioma should be based on AFC rather than AMH, as the latter may be overestimated.
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Affiliation(s)
- Iñaki González-Foruria
- Dexeus Mujer, Department of Reproductive Medicine, Dexeus University Hospital, Barcelona, Spain.
| | - Pedro Barri Soldevila
- Dexeus Mujer, Department of Reproductive Medicine, Dexeus University Hospital, Barcelona, Spain
| | - Ignacio Rodríguez
- Dexeus Mujer, Department of Reproductive Medicine, Dexeus University Hospital, Barcelona, Spain
| | - Jorge Rodríguez-Purata
- Dexeus Mujer, Department of Reproductive Medicine, Dexeus University Hospital, Barcelona, Spain
| | - Clara Pardos
- Dexeus Mujer, Department of Reproductive Medicine, Dexeus University Hospital, Barcelona, Spain
| | - Sandra García
- Dexeus Mujer, Department of Reproductive Medicine, Dexeus University Hospital, Barcelona, Spain
| | - M Ángela Pascual
- Dexeus Mujer, Department of Reproductive Medicine, Dexeus University Hospital, Barcelona, Spain
| | - Pedro N Barri
- Dexeus Mujer, Department of Reproductive Medicine, Dexeus University Hospital, Barcelona, Spain
| | - Nikolaos P Polyzos
- Dexeus Mujer, Department of Reproductive Medicine, Dexeus University Hospital, Barcelona, Spain
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Sanchez AM, Pagliardini L, Cermisoni GC, Privitera L, Makieva S, Alteri A, Corti L, Rabellotti E, Candiani M, Viganò P. Does Endometriosis Influence the Embryo Quality and/or Development? Insights from a Large Retrospective Matched Cohort Study. Diagnostics (Basel) 2020; 10:diagnostics10020083. [PMID: 32028668 PMCID: PMC7168899 DOI: 10.3390/diagnostics10020083] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 01/27/2020] [Accepted: 01/31/2020] [Indexed: 12/18/2022] Open
Abstract
In vitro fertilization can be an effective tool to manage the endometriosis-associated infertility, which accounts for 10% of the strategy indications. Nevertheless, a negative effect of endometriosis on IVF outcomes has been suggested. The aim of this study was to evaluate the potential effect of endometriosis in the development of embryos at cleavege stage in assisted reproduction treatment cycles. A total of 429 cycles from women previously operated for moderate/severe endometriosis were compared with 851 cycles from non-affected women. Patients were matched by age, number of oocyte retrieved and study period. A total of 3818 embryos in cleavage stage have been analyzed retrospectively. Overall, no difference was found between women with and without endometriosis regarding the number of cleavage stage embryos obtained as well as the percentage of good/fair quality embryos. Excluding cycles in which no transfers were performed or where embryos were frozen in day three, no difference was observed for blastulation rate or the percentage of good/fair blastocysts obtained. Despite similar fertilization rate and number/quality of embryos, a reduction in ongoing pregnancy rate was observed in patients affected, possibly due to an altered endometrial receptivity or to the limited value of the conventional morphological evaluation of the embryo.
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Affiliation(s)
- Ana M. Sanchez
- Reproductive Sciences Laboratory, Division of Genetics and Cell Biology, IRCCS San Raffaele Scientific Institute, 20132 Milano, Italy; (A.M.S.); (S.M.); (P.V.)
| | - Luca Pagliardini
- Reproductive Sciences Laboratory, Division of Genetics and Cell Biology, IRCCS San Raffaele Scientific Institute, 20132 Milano, Italy; (A.M.S.); (S.M.); (P.V.)
- Correspondence:
| | - Greta C. Cermisoni
- IRCCS San Raffaele Scientific Institute, Obstetrics and Gynecology Unit, 20132 Milano, Italy; (G.C.C.); (L.P.); (A.A.); (L.C.); (E.R.); (M.C.)
| | - Laura Privitera
- IRCCS San Raffaele Scientific Institute, Obstetrics and Gynecology Unit, 20132 Milano, Italy; (G.C.C.); (L.P.); (A.A.); (L.C.); (E.R.); (M.C.)
| | - Sofia Makieva
- Reproductive Sciences Laboratory, Division of Genetics and Cell Biology, IRCCS San Raffaele Scientific Institute, 20132 Milano, Italy; (A.M.S.); (S.M.); (P.V.)
| | - Alessandra Alteri
- IRCCS San Raffaele Scientific Institute, Obstetrics and Gynecology Unit, 20132 Milano, Italy; (G.C.C.); (L.P.); (A.A.); (L.C.); (E.R.); (M.C.)
| | - Laura Corti
- IRCCS San Raffaele Scientific Institute, Obstetrics and Gynecology Unit, 20132 Milano, Italy; (G.C.C.); (L.P.); (A.A.); (L.C.); (E.R.); (M.C.)
| | - Elisa Rabellotti
- IRCCS San Raffaele Scientific Institute, Obstetrics and Gynecology Unit, 20132 Milano, Italy; (G.C.C.); (L.P.); (A.A.); (L.C.); (E.R.); (M.C.)
| | - Massimo Candiani
- IRCCS San Raffaele Scientific Institute, Obstetrics and Gynecology Unit, 20132 Milano, Italy; (G.C.C.); (L.P.); (A.A.); (L.C.); (E.R.); (M.C.)
| | - Paola Viganò
- Reproductive Sciences Laboratory, Division of Genetics and Cell Biology, IRCCS San Raffaele Scientific Institute, 20132 Milano, Italy; (A.M.S.); (S.M.); (P.V.)
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17
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Yland J, Carvalho LFP, Beste M, Bailey A, Thomas C, Abrão MS, Racowsky C, Griffith L, Missmer SA. Endometrioma, the follicular fluid inflammatory network and its association with oocyte and embryo characteristics. Reprod Biomed Online 2019; 40:399-408. [PMID: 32057676 DOI: 10.1016/j.rbmo.2019.12.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 11/11/2019] [Accepted: 12/10/2019] [Indexed: 01/23/2023]
Abstract
RESEARCH QUESTION What is the association between endometrioma-affected ovaries, their follicular fluid inflammatory microenvironment, and ovary-specific oocyte and embryo yield and quality? DESIGN Exposure-matched prospective cohort study conducted at a university-affiliated infertility clinic. Thirty-four women presenting for oocyte retrieval were enrolled between 2012 and 2013: women with unilateral endometrioma and no other observed peritoneal or deep lesions (n = 10) and women with no signs or symptoms of endometriosis (n = 24). Follicular fluid was aspirated at the time of oocyte retrieval. Samples from each ovary were analysed using a 27-plex immunoassay panel. The associations were evaluated by ovary-specific endometrioma exposure status (affected, unaffected, unexposed) with cytokine levels, oocyte yield and embryo quality. RESULTS Levels of interleukin (IL)-8 and monocyte chemoattractant protein-1 were higher in fluid obtained from endometrioma-affected ovaries compared with the unexposed ovaries from women without endometriosis, with intermediate levels observed in the contralateral unaffected ovaries. More modest differences were observed for IL-1β and IL-6. The affected ovaries of women with endometriosis yielded fewer oocytes (mean ± SD = 4.6 ± 2.3) compared with both the unaffected (6.0 ± 3.8) and unexposed (7.9 ± 5.6) ovaries. After adjusting for potential confounders and variables generated in a cytokine principal components analysis, oocyte yield remained slightly lower for the endometrioma-affected ovaries compared with unexposed ovaries. No informative differences among ovary groups for embryo quality parameters were observed. CONCLUSIONS The results suggest that the inflammatory milieu of ovarian endometriosis is strongly localized and has a more modestly systemic effect. The effect of endometriomas on infertility, however, cannot be entirely explained by increased inflammation.
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Affiliation(s)
- Jennifer Yland
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA.
| | - Luiz Fernando Pina Carvalho
- Department of Obstetrics and Gynecology, São Paulo University, Butanta, São Paulo, Brazil; Baby Center, Center for Reproductive Medicine, R. Joaquim Floriano, São Paulo, 04534-002, Brazil
| | - Michael Beste
- Novartis Institutes for BioMedical Research, 250 Massachusetts Avenue, Cambridge MA, 02139, USA
| | - Amelia Bailey
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Vanderbilt University School of Medicine, 1161 21st Avenue S, Nashville TN 37232, USA; Fertility Associates of Memphis, 80 Humphreys Center, Memphis TN, 38120, USA
| | - Cassandra Thomas
- Center for Infertility and Reproductive Surgery, Brigham and Women's Hospital and Harvard Medical School, 75 Francis St, Boston MA, 02115, USA
| | - Mauricio S Abrão
- Department of Obstetrics and Gynecology, São Paulo University, Butanta, São Paulo, Brazil; Center for Gynepathology Research, Department of Biological Engineering, Massachusetts Institute of Technology, 21 Ames St, Cambridge TN, 02142, USA
| | - Catherine Racowsky
- Center for Infertility and Reproductive Surgery, Brigham and Women's Hospital and Harvard Medical School, 75 Francis St, Boston MA, 02115, USA
| | - Linda Griffith
- Center for Gynepathology Research, Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge MA, USA
| | - Stacey A Missmer
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA; Boston Center for Endometriosis, Boston Children's and Brigham and Women's Hospitals, Boston MA, USA; Department of Obstetrics, Gynecology, and Reproductive Biology, Michigan State University, 400 Monroe Avenue NW, Grand Rapids MI, 49503, USA
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18
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Georgiou EX, Melo P, Baker PE, Sallam HN, Arici A, Garcia‐Velasco JA, Abou‐Setta AM, Becker C, Granne IE. Long-term GnRH agonist therapy before in vitro fertilisation (IVF) for improving fertility outcomes in women with endometriosis. Cochrane Database Syst Rev 2019; 2019:CD013240. [PMID: 31747470 PMCID: PMC6867786 DOI: 10.1002/14651858.cd013240.pub2] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Endometriosis is known to have an impact on fertility and it is common for women affected by endometriosis to require fertility treatments, including in vitro fertilisation (IVF) or intracytoplasmic sperm injection (ICSI), to improve the chance of pregnancy. It has been postulated that long-term gonadotrophin-releasing hormone (GnRH) agonist therapy prior to IVF or ICSI can improve pregnancy outcomes. This systematic review supersedes the previous Cochrane Review on this topic (Sallam 2006). OBJECTIVES To determine the effectiveness and safety of long-term gonadotrophin-releasing hormone (GnRH) agonist therapy (minimum 3 months) versus no pretreatment or other pretreatment modalities, such as long-term continuous combined oral contraception (COC) or surgical therapy of endometrioma, before standard in vitro fertilisation (IVF) or intracytoplasmic sperm injection (ICSI) in women with endometriosis. SEARCH METHODS We searched the following electronic databases from their inception to 8 January 2019: Cochrane Gynaecology and Fertility Specialised Register of Controlled Trials, CENTRAL via the Cochrane CENTRAL Register of Studies ONLINE (CRSO), MEDLINE, Embase, PsycINFO, Cumulative Index to Nursing and Allied Health Literature (CINAHL). We searched trial registries to identify unpublished and ongoing trials. We also searched DARE (Database of Abstracts of Reviews of Effects), Web of Knowledge, OpenGrey, Latin American and Caribbean Health Science Information Database (LILACS), PubMed, Google and reference lists from relevant papers for any other relevant trials. SELECTION CRITERIA Randomised controlled trials (RCTs) involving women with surgically diagnosed endometriosis that compared use of any type of GnRH agonist for at least three months before an IVF/ICSI protocol to no pretreatment or other pretreatment modalities, specifically use of long-term continuous COC (minimum of 6 weeks) or surgical excision of endometrioma within six months prior to standard IVF/ICSI. The primary outcomes were live birth rate and complication rate per woman randomised. DATA COLLECTION AND ANALYSIS Two independent review authors assessed studies against the inclusion criteria, extracted data and assessed risk of bias. A third review author was consulted, if required. We contacted the study authors, as required. We analysed dichotomous outcomes using Mantel-Haenszel risk ratios (RRs), 95% confidence intervals (CIs) and a fixed-effect model. For small numbers of events, we used a Peto odds ratio (OR) with 95% CI instead. We analysed continuous outcomes using the mean difference (MD) between groups and presented with 95% CIs. We studied heterogeneity of the studies via the I2 statistic. We assessed the quality of evidence using GRADE criteria. MAIN RESULTS We included eight parallel-design RCTs, involving a total of 640 participants. We did not assess any of the studies as being at low risk of bias across all domains, with the main limitation being lack of blinding. Using GRADE methodology, the quality of the evidence ranged from very low to low quality. Long-term GnRH agonist therapy versus no pretreatment We are uncertain whether long-term GnRH agonist therapy affects the live birth rate (RR 0.48, 95% CI 0.26 to 0.87; 1 RCT, n = 147; I2 not calculable; very low-quality evidence) or the overall complication rate (Peto OR 1.23, 95% CI 0.37; to 4.14; 3 RCTs, n = 318; I2 = 73%; very low-quality evidence) compared to standard IVF/ICSI. Further, we are uncertain whether this intervention affects the clinical pregnancy rate (RR 1.13, 95% CI 0.91 to 1.41; 6 RCTs, n = 552, I2 = 66%; very low-quality evidence), multiple pregnancy rate (Peto OR 0.14, 95% CI 0.03 to 0.56; 2 RCTs, n = 208, I2 = 0%; very low-quality evidence), miscarriage rate (Peto OR 0.45, 95% CI 0.10 to 2.00; 2 RCTs, n = 208; I2 = 0%; very low-quality evidence), mean number of oocytes (MD 0.72, 95% CI 0.06 to 1.38; 4 RCTs, n = 385; I2 = 81%; very low-quality evidence) or mean number of embryos (MD -0.76, 95% CI -1.33 to -0.19; 2 RCTs, n = 267; I2 = 0%; very low-quality evidence). Long-term GnRH agonist therapy versus long-term continuous COC No studies reported on this comparison. Long-term GnRH agonist therapy versus surgical therapy of endometrioma No studies reported on this comparison. AUTHORS' CONCLUSIONS This review raises important questions regarding the merit of long-term GnRH agonist therapy compared to no pretreatment prior to standard IVF/ICSI in women with endometriosis. Contrary to previous findings, we are uncertain as to whether long-term GnRH agonist therapy impacts on the live birth rate or indeed the complication rate compared to standard IVF/ICSI. Further, we are uncertain whether this intervention impacts on the clinical pregnancy rate, multiple pregnancy rate, miscarriage rate, mean number of oocytes and mean number of embryos. In light of the paucity and very low quality of existing data, particularly for the primary outcomes examined, further high-quality trials are required to definitively determine the impact of long-term GnRH agonist therapy on IVF/ICSI outcomes, not only compared to no pretreatment, but also compared to other proposed alternatives to endometriosis management.
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Affiliation(s)
| | - Pedro Melo
- Buckinghamshire Hospitals NHS TrustAylesburyUK
| | - Philip E Baker
- Oxford University Hospitals NHS TrustAcademic CentreJohn Radcliffe HospitalHeadley Way, HeadingtonOxfordUKOX3 9DU
| | - Hassan N Sallam
- Alexandria UniversityObstetrics and Gynaecology22 Victor Emanuel SquareSmouhaAlexandriaEgypt21615
| | - Aydin Arici
- Yale UniversityReproductive Endocrinology Section333 Cedar StNew HavenConnecticutUSA06520‐8063
| | - Juan A Garcia‐Velasco
- IVI MadridInstituto Valenciano de Infertilidad Madridc/o Santiago de Compostela 88MadridSpain28025
| | - Ahmed M Abou‐Setta
- University of ManitobaKnowledge Synthesis Platform, George and Fay Yee Centre for Healthcare InnovationChown Building367‐753 McDermot AveWinnipegMBCanadaR3E 0W3
| | - Christian Becker
- University of OxfordNuffield Department of Women's & Reproductive HealthJohn Radcliffe HospitalWomen's CentreOxfordOxonUKOX3 9DU
| | - Ingrid E Granne
- University of OxfordNuffield Department of Women's & Reproductive HealthJohn Radcliffe HospitalWomen's CentreOxfordOxonUKOX3 9DU
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19
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van der Houwen LEE, Lier MCI, Schreurs AMF, van Wely M, Hompes PGA, Cantineau AEP, Schats R, Lambalk CB, Mijatovic V. Continuous oral contraceptives versus long-term pituitary desensitization prior to IVF/ICSI in moderate to severe endometriosis: study protocol of a non-inferiority randomized controlled trial. Hum Reprod Open 2019; 2019:hoz001. [PMID: 30895266 PMCID: PMC6396644 DOI: 10.1093/hropen/hoz001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 11/17/2018] [Accepted: 01/26/2019] [Indexed: 11/13/2022] Open
Abstract
STUDY QUESTIONS The primary objective is to investigate if continuous use of oral contraceptives is non-inferior compared to long-term pituitary desensitization with a GnRH agonist prior to IVF/ICSI in patients with moderate to severe endometriosis with regard to treatment efficacy. Secondary objectives concern treatment safety and cost-effectiveness. WHAT IS KNOWN ALREADY Long-term pituitary desensitization with a GnRH agonist for 3-6 months prior to IVF/ICSI improves clinical pregnancy rates in women suffering from endometriosis. However, discussion about this treatment strategy exists because of its uncomfortable side effects. Alternatively, IVF/ICSI pre-treatment with continuously administered oral contraceptives may offer fewer side-effects and lower (in)direct costs, as well as encouraging IVF outcomes in women with endometriosis. To date, these two different IVF/ICSI pre-treatment strategies in women with endometriosis have not been directly compared. STUDY DESIGN SIZE DURATION An open-label, parallel two-arm randomized controlled multicenter trial is planned, including patients with moderate to severe endometriosis. To demonstrate an absolute difference of 13% (delta of 10% with non-inferiority margin of 3%) with a power of 80% 137 patients per group are sufficient. Taking into account a withdrawal of patients of 10% and a cancelation rate of embryo transfer after ovarian pick up of 10% (for instance due to fertilization failure), the sample size calculation is rounded off to 165 patients per group; 330 patients in total will be included. After informed consent, eligible patients will be randomly allocated to the intervention or reference group by using web based block randomization stratified per centre. Study inclusion is expected to be complete in 3-5 years. PARTICIPANTS/MATERIALS SETTING METHODS The research population consists of patients with moderate to severe endometriosis (ASRM III/IV) who are scheduled for their first, second or third IVF/ICSI treatment attempt. Women aged over 41 years, younger than 18 years, with a known contraindication for the use of oral contraceptives and/or GnRH agonists or with severe male factor infertility will be excluded from participation. After informed consent patients are allocated to the intervention group (one-phase oral contraceptive continuously during three subsequent months) or the reference group (three Leuprorelin 3.75 mg i.m./s.c. depot injections during three subsequent months). Tibolon 2.5 mg can be given daily as add-back therapy in the reference group. After 3 months of pre-treatment the IVF/ICSI stimulation phase will be started. The primary outcome is live birth rate after fresh embryo transfer. Secondary outcomes are cumulative live birth rate after one IVF/ICSI treatment cycle (including fresh and frozen embryo transfers up to 15 months after randomization), ongoing pregnancy rate and time to pregnancy. In addition, treatment outcome parameters, adverse events, side-effects during the first 3 months, complications, recurrence of endometriosis (complaints), quality of life, patient preferences, safety and costs effectiveness will be reported. Measurements will be performed at baseline and at 3, 6, 9, 12 and 15 months after randomization. STUDY FUNDING/COMPETING INTERESTS All authors have no conflict of interest related to this manuscript. The department of reproductive medicine of the Amsterdam UMC location VUmc has received several research and educational grants from Guerbet, Merck and Ferring not related to the submitted work. TRIAL REGISTRATION NUMBER The trial is registered as the COPIE trial (Continuous use of Oral contraceptives as an alternative for long-term Pituitary desensitization with a GnRH agonist prior to IVF/ICSI in Endometriosis patients) in the Dutch Trial Register (Ref. No. NTR6357, http://www.trialregister.nl). TRIAL REGISTRATION DATE 16 March 2017. DATE OF FIRST PATIENT’S ENROLMENT Enrollment is planned for November 2018.
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Affiliation(s)
- L E E van der Houwen
- Amsterdam UMC, Vrije Universiteit Amsterdam, Endometriosis Centre VUmc, Department of Reproductive Medicine, De Boelelaan 1117, Amsterdam, the Netherlands
| | - M C I Lier
- Amsterdam UMC, Vrije Universiteit Amsterdam, Endometriosis Centre VUmc, Department of Reproductive Medicine, De Boelelaan 1117, Amsterdam, the Netherlands
| | - A M F Schreurs
- Amsterdam UMC, Vrije Universiteit Amsterdam, Endometriosis Centre VUmc, Department of Reproductive Medicine, De Boelelaan 1117, Amsterdam, the Netherlands
| | - M van Wely
- Amsterdam UMC, University of Amsterdam, Centre for Reproductive Medicine, Meibergdreef 9, Amsterdam-Zuidoost, the Netherlands
| | - P G A Hompes
- Amsterdam UMC, Vrije Universiteit Amsterdam, Endometriosis Centre VUmc, Department of Reproductive Medicine, De Boelelaan 1117, Amsterdam, the Netherlands
| | - A E P Cantineau
- University of Groningen, University Medical Center Groningen, Hanzeplein 1, Groningen, The Netherlands
| | - R Schats
- Amsterdam UMC, Vrije Universiteit Amsterdam, Endometriosis Centre VUmc, Department of Reproductive Medicine, De Boelelaan 1117, Amsterdam, the Netherlands
| | - C B Lambalk
- Amsterdam UMC, Vrije Universiteit Amsterdam, Endometriosis Centre VUmc, Department of Reproductive Medicine, De Boelelaan 1117, Amsterdam, the Netherlands
| | - V Mijatovic
- Amsterdam UMC, Vrije Universiteit Amsterdam, Endometriosis Centre VUmc, Department of Reproductive Medicine, De Boelelaan 1117, Amsterdam, the Netherlands
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Jaafar SH, Sallam HN, Arici A, Garcia-Velasco JA, Abou-Setta AM. Long-term GnRH agonist therapy before in vitro fertilization (IVF) for improving fertility outcomes in women with endometriosis. Hippokratia 2019. [DOI: 10.1002/14651858.cd013240] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Sharifah Halimah Jaafar
- Regency Specialist Hospital; Department of Obstetrics and Gynaecology; No 1 Jalan Suria, Bandar Seri Alam Johor Bahru Johor Malaysia 81750
| | - Hassan N Sallam
- Alexandria University; Obstetrics and Gynaecology; 22 Victor Emanuel Square Smouha Alexandria Egypt 21615
| | - Aydin Arici
- Yale University; Reproductive Endocrinology Section; 333 Cedar St New Haven Connecticut USA 06520-8063
| | - Juan A Garcia-Velasco
- IVI Madrid; Instituto Valenciano de Infertilidad Madrid; c/o Santiago de Compostela 88 Madrid Spain 28025
| | - Ahmed M Abou-Setta
- University of Manitoba; Knowledge Synthesis Platform, George and Fay Yee Centre for Healthcare Innovation; Chown Building 367-753 McDermot Ave Winnipeg MB Canada R3E 0W3
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Amaral MEB, Ejzenberg D, Wajman DS, Monteleone PAA, Serafini P, Soares JM, Baracat EC. Risk factors for inadequate response to ovarian stimulation in assisted reproduction cycles: systematic review. J Assist Reprod Genet 2018; 36:19-28. [PMID: 30269205 DOI: 10.1007/s10815-018-1324-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 09/20/2018] [Indexed: 02/07/2023] Open
Abstract
PURPOSE Controlled ovarian stimulation is a fundamental part of a successful assisted reproduction treatment, and recognizing patients at risk of a poor response allows the development of targeted research to propose new treatment strategies for this specific group. The objective of this systematic review was to determine risk factors for poor ovarian response (POR) to controlled stimulation in assisted reproduction cycles described in the literature. METHODS The primary databases MEDLINE, Cochrane, LILACS, and SciELO were consulted, using specific terms with a restriction for articles in English or Portuguese published in the last 10 years. RESULTS AND CONCLUSION Our data suggest that environmental endocrine disruptors, tobacco, genetic mutations, endometriomas, ovarian surgery, chemotherapy, and short menstrual cycles are factors that influence stimulation in assisted reproduction cycles. Further studies are necessary for characterizing patients with prior risk factors.
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Affiliation(s)
- Maria Eduarda Bonavides Amaral
- Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 255, Cerqueira César, São Paulo, 05403-000, Brazil
| | - Dani Ejzenberg
- Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 255, Cerqueira César, São Paulo, 05403-000, Brazil.
| | - Denis Schapira Wajman
- Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 255, Cerqueira César, São Paulo, 05403-000, Brazil
| | - Pedro Augusto Araújo Monteleone
- Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 255, Cerqueira César, São Paulo, 05403-000, Brazil
| | - Paulo Serafini
- Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 255, Cerqueira César, São Paulo, 05403-000, Brazil
| | - Jose Maria Soares
- Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 255, Cerqueira César, São Paulo, 05403-000, Brazil
| | - Edmund Chada Baracat
- Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 255, Cerqueira César, São Paulo, 05403-000, Brazil
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Murta M, Machado RC, Zegers-Hochschild F, Checa MA, Sampaio M, Geber S. Endometriosis does not affect live birth rates of patients submitted to assisted reproduction techniques: analysis of the Latin American Network Registry database from 1995 to 2011. J Assist Reprod Genet 2018; 35:1395-1399. [PMID: 29946760 DOI: 10.1007/s10815-018-1214-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 05/16/2018] [Indexed: 01/27/2023] Open
Abstract
PURPOSE The purpose of this study is to compare the results of ART treatment in patients with and without endometriosis in a large cohort of patients from different centers over an extented period of time. METHODS This retrospective study is using data from patients undergoing 27,294 cycles of IVF/ICSI treatment between 1995 and 2011 that were registered in the database of the Latin American Registry maintained by the Latin America Network of Assisted Reproduction. RESULTS The mean number of retrieved oocytes was higher in the control group, but the mean number of metaphase II oocytes was similar. Fertilization rate and transfer rate were higher in the control group. We observed higher pregnancy rates, per cycle initiated and per embryo transfer and higher live birth rate in the endometriosis group. In the group of patients with 25-35 years old, the number of oocytes, fertilization rate, and number of transferred embryos were significantly higher in the control group. However, pregnancy rate and live birth rate were higher in the endometriosis group. In the group of patients with 36-40 years old, the number of transferred embryos was higher in the control group, but the pregnancy rate and live birth rate were higher in the endometriosis group. In the group of patients with 41 to 42 years old, the number of transferred embryos and the transfer rate were higher in the control group, but the pregnancy rate was higher in the endometriosis group. CONCLUSION Our results demonstrate that endometriosis does not affect the outcome of patients subjected to IVF/ICSI and although patients with endometriosis present lower number of oocytes and higher cancelation rate, these shortcomings do not reduce pregnancy and live birth rates.
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Affiliation(s)
- Mário Murta
- Clínica NeoVitae/ORIGEN, Governador Valadares, Brazil.,Maaster Internacional Medicina Reproductiva, Hospital del Mar, Barcelona, Spain
| | | | - Fernando Zegers-Hochschild
- The Latin American Registry of ART, Montevideo, Uruguay.,Unit of Reproductive Medicine, Clinica las Condes, and Program of Ethics and Public Policies in Human Reproduction University Diego Portales, Santiago, Chile
| | - Miguel Angel Checa
- Universitat Autònoma de Barcelona, Barcelona, Spain.,Department of Obstetrics and Gynecology, Parc de Salut Mar, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Marcos Sampaio
- ORIGEN, Center for Reproductive Medicine, Belo Horizonte, Brazil
| | - Selmo Geber
- ORIGEN, Center for Reproductive Medicine, Belo Horizonte, Brazil. .,Department of Obstetrics and Gynecology, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil. .,, Belo Horizonte, Brazil.
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Vassilopoulou L, Matalliotakis M, Zervou MI, Matalliotaki C, Spandidos DA, Matalliotakis I, Goulielmos GN. Endometriosis and in vitro fertilisation. Exp Ther Med 2018; 16:1043-1051. [PMID: 30116357 PMCID: PMC6090275 DOI: 10.3892/etm.2018.6307] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 06/13/2018] [Indexed: 01/06/2023] Open
Abstract
The aim of the present review was to discuss a matter of concern in the clinical field of obstetrics/gynecology, namely the potency of in vitro fertilization (IVF) in the management of endometriosis-associated infertility. Endometriosis is a medical condition affecting one tenth of women in their fertile years, and accounts for up to 50% of infertile women. Thus, such high prevalence has established the necessity for investigating the effectiveness of available techniques in eradicating the disease and constraining infertility as well as the accompanying pain symptoms of endometriosis. The underlying mechanisms connecting endometriosis with low fecundity have been extensively studied, both in terms of genetic alterations and epigenetic events that contribute to the manifestation of an infertility phenotype in women with the disease. Several studies have dealt with the impact of IVF in pregnancy rates (PRs) on patients with endometriosis, particularly regarding women who wish to conceive. Results retrieved from studies and meta-analyses depict a diverse pattern of IVF success, underlining the involvement of individual parameters in the configuration of the final outcome. The ultimate decision on undergoing IVF treatment should be based on objective criteria and clinicians' experience, customized according to patients' individual needs.
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Affiliation(s)
- Loukia Vassilopoulou
- Laboratory of Forensic Sciences and Toxicology, Medical School, University of Crete, Heraklion 71409, Crete, Greece
| | - Michail Matalliotakis
- Department of Obstetrics and Gynecology, Venizeleio and Pananio General Hospital of Heraklion, Heraklion 71409, Crete, Greece
| | - Maria I Zervou
- Section of Molecular Pathology and Human Genetics, Department of Internal Medicine, School of Medicine, University of Crete, Heraklion 71003, Crete, Greece
| | - Charoula Matalliotaki
- Department of Obstetrics and Gynecology, Venizeleio and Pananio General Hospital of Heraklion, Heraklion 71409, Crete, Greece
| | - Demetrios A Spandidos
- Laboratory of Clinical Virology, Medical School, University of Crete, Heraklion 71003, Crete, Greece
| | - Ioannis Matalliotakis
- Department of Obstetrics and Gynecology, Venizeleio and Pananio General Hospital of Heraklion, Heraklion 71409, Crete, Greece
| | - George N Goulielmos
- Section of Molecular Pathology and Human Genetics, Department of Internal Medicine, School of Medicine, University of Crete, Heraklion 71003, Crete, Greece
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Mathieu d'Argent E, Cohen J, Chauffour C, Pouly JL, Boujenah J, Poncelet C, Decanter C, Santulli P. [Deeply infiltrating endometriosis and infertility: CNGOF-HAS Endometriosis Guidelines]. ACTA ACUST UNITED AC 2018; 46:357-367. [PMID: 29544710 DOI: 10.1016/j.gofs.2018.02.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Indexed: 01/27/2023]
Abstract
Deeply infiltrating endometriosis is a severe form of the disease, defined by endometriotic tissue peritoneal infiltration. The disease may involve the rectovaginal septum, uterosacral ligaments, digestive tract or bladder. Deeply infiltrating endometriosis is responsible for disabling pain and infertility. The purpose of these recommendations is to answer the following question: in case of deeply infiltrating endometriosis associated infertility, what is the best therapeutic strategy? First-line surgery and then in vitro fertilization (IVF) in case of persistent infertility or first-line IVF, without surgery? After exhaustive literature analysis, we suggest the following recommendations: studies focusing on spontaneous fertility of infertile patients with deeply infiltrating endometriosis found spontaneous pregnancy rates about 10%. Treatment should be considered in infertile women with deeply infiltrating endometriosis when they wish to conceive. First-line IVF is a good option in case of no operated deeply infiltrating endometriosis associated infertility. Pregnancy rates (spontaneous and following assisted reproductive techniques) after surgery (deep lesions without colorectal involvement) varie from 40 to 85%. After colorectal endometriosis resection, pregnancy rates vary from 47 to 59%. The studies comparing the pregnancy rates after IVF, whether or not preceded by surgery, are contradictory and do not allow, to date, to conclude on the interest of any surgical management of deep lesions before IVF. In case of alteration of ovarian reserve parameters (age, AMH, antral follicle count), there is no argument to recommend first-line surgery or IVF. The study of the literature does not identify any prognostic factors, allowing to chose between surgical management or IVF. The use of IVF in the indication "deep infiltrating endometriosis" allows satisfactory pregnancy rates without significant risk, regarding disease progression or oocyte retrieval procedure morbidity.
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Affiliation(s)
- E Mathieu d'Argent
- Service de gynécologie obstétrique et médecine de la reproduction, GRC6-UPMC, centre expert en endométriose (C3E), université Pierre-et-Marie-Curie Paris 6, hôpital Tenon, CHU de Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France.
| | - J Cohen
- Service de gynécologie obstétrique et médecine de la reproduction, GRC6-UPMC, centre expert en endométriose (C3E), université Pierre-et-Marie-Curie Paris 6, hôpital Tenon, CHU de Tenon, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - C Chauffour
- Service de gynécologie obstétrique et reproduction humaine, CHU Estaing, 1, place Lucie-Aubrac, 63003 Clermont-Ferrand, France
| | - J L Pouly
- Service de gynécologie obstétrique et reproduction humaine, CHU Estaing, 1, place Lucie-Aubrac, 63003 Clermont-Ferrand, France
| | - J Boujenah
- Service de gynécologie obstétrique, CHU de Bondy, avenue du 14-Juillet, 93140 Bondy, France; Centre médical du Château, 22, rue Louis-Besquel, 94300 Vincennes, France
| | - C Poncelet
- Service de gynécologie obstétrique, centre hospitalier Renée-Dubos, 6, avenue de l'Île-de-France, 95300 Pontoise, France; UFR SMBH, université Paris 13, Sorbonne Paris-Cité, 93022 Bobigny, France
| | - C Decanter
- EA 4308 Gamétogenèse et qualité du gamète, service d'assistance médicale à la procréation et de préservation de la fertilité, hôpital Jeanne-de-Flandre, CHRU de Lille, 1, rue Eugène-Avinée, 59037 Lille cedex, France
| | - P Santulli
- Service de chirurgie gynécologie obstétrique 2 et médecine de la reproduction, CHU de Cochin, AP-HP, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France; Inserm U1016, équipe génomique, épigénétique et physiopathologie de la reproduction, département développement, reproduction, cancer, université Paris-Descartes, Sorbonne Paris-Cité, 12, rue de l'École-de-Médecine, 75270 Paris cedex 06, France
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[Management by assisted reproductive technology in women with endometriosis: CNGOF-HAS Endometriosis Guidelines]. ACTA ACUST UNITED AC 2018. [PMID: 29523480 DOI: 10.1016/j.gofs.2018.02.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Should the presence of endometriosis change the management of assisted reproductive technology? There is no difference in pregnancy rate after IVF between an agonist or antagonist protocol in patients with endometriosis, so the choice between one or the other of these protocols is free. But the review of the literature has shown an improvement in the chances of pregnancy in case of prolonged ovulation suppression before stimulation for IVF with a GnRH agonist analogue or with oral contraception, especially in cases of severe endometriosis. Endometriosis, regardless of the stage and type of lesions, would have no effect on the IVF results in terms of pregnancy rate and live birth rate, but with a lower number of oocytes collected, especially in cases of severe endometriosis. In a context of superficial endometriosis without pain and of infertility, surgical treatment of superficial endometriosis is not recommended just to increase the chances of pregnancy in IVF. Surgery may have a place in case of failure of IVF to improve the results of the ART. In case of recurrence of endometriosis, surgery is not better than IVF, a medico-surgical concertation is recommended. In addition, studies on ovulation stimulation for IVF do not show any aggravation of the symptoms associated with endometriosis lesions, or an acceleration of its progression, or an increase in the rate of recurrence of the disease.
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Šalamun V, Verdenik I, Laganà AS, Vrtačnik-Bokal E. Should we consider integrated approach for endometriosis-associated infertility as gold standard management? Rationale and results from a large cohort analysis. Arch Gynecol Obstet 2017; 297:613-621. [PMID: 29274003 DOI: 10.1007/s00404-017-4633-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 12/15/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE To evaluate reproductive and maternal-fetal outcomes after integrated approach for endometriosis-associated infertility (EAI). METHODS We retrospectively analyzed reproductive and maternal-fetal outcomes of 277 women affected by EAI, subdividing patients in two groups: in the first one (surgery group), we included all women who underwent laparoscopic surgery for EAI; in the second one (integrated group), we included women who failed to conceive spontaneously after surgery within 6-12 months and underwent in vitro fertilization and embryo transfer (IVF). We evaluated delivery rate (DR), maternal and neonatal outcomes of the first pregnancies, and, finally, the type (spontaneous or IVF) of subsequent pregnancies. RESULTS We did not find significant difference regarding DR between surgery and integrated groups. We found significantly lower birth weight (p < 0.001) and gestational age at delivery (p < 0.001) in integrated group respect to surgery group; conversely, we found higher rate of preterm birth (p < 0.001), small for gestational age (p = 0.003), and admission to the neonatal intensive care unit (p < 0.001) respect to surgery group. Finally, 92 women became pregnant for the second time: 8% were spontaneous and 20% were IVF pregnancies. CONCLUSIONS We suggest the integrated approach as gold standard treatment for carefully selected patients (young, good ovarian reserve, partner with normal semen parameters) affected by EAI. As consequence, IVF should be reserved as the secondary treatment for women who fail to conceive spontaneously after surgery within 6-12 months, since it is able to increase DR significantly.
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Affiliation(s)
- Vesna Šalamun
- Division of Obstetrics and Gynecology, Department of Human Reproduction, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Ivan Verdenik
- Division of Obstetrics and Gynecology, Department of Human Reproduction, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Antonio Simone Laganà
- Unit of Gynecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood "G. Barresi", University of Messina, Via C. Valeria 1, 98125, Messina, Italy.
| | - Eda Vrtačnik-Bokal
- Division of Obstetrics and Gynecology, Department of Human Reproduction, University Medical Centre Ljubljana, Ljubljana, Slovenia
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AlKudmani B, Gat I, Buell D, Salman J, Zohni K, Librach C, Sharma P. In Vitro Fertilization Success Rates after Surgically Treated Endometriosis and Effect of Time Interval between Surgery and In Vitro Fertilization. J Minim Invasive Gynecol 2017; 25:99-104. [PMID: 28807807 DOI: 10.1016/j.jmig.2017.08.641] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 07/24/2017] [Accepted: 08/08/2017] [Indexed: 02/08/2023]
Abstract
STUDY OBJECTIVE To evaluate the impact of endometriosis staging and endometriomas on in vitro fertilization (IVF) outcome and to assess the optimal time interval between laparoscopy and IVF. DESIGN A retrospective clinical study (Canadian Task Force classification II1). SETTING A university-affiliated private infertility clinic. PATIENTS Two hundred sixteen infertile patients with endometriosis and 209 infertile patients without endometriosis. INTERVENTIONS Laparoscopy, IVF. MEASUREMENTS AND MAIN RESULTS Patients with endometriosis were classified according to American Society for Reproductive Medicine criteria; 58, 67, 63, and 28 patients had stages 1 through 4 disease, respectively. Patients with endometriosis had significantly lower estradiol on trigger day (9986 ± 6710 vs 12 220 ± 9414 pg/mL, respectively) and number of retrieved oocytes (12.7 ± 8.6 vs 14.0 ± 10, respectively) compared with controls. We found a consistent decline in clinical and ongoing pregnancy rates with increasing stage of endometriosis. The presence of endometrioma in patients with stages 3 and 4 endometriosis did not alter IVF outcome. Patients with a time interval of 7 to 12 and 13 to 25 months after surgery had a favorable outcome. CONCLUSION IVF pregnancy rate was negatively correlated with endometriosis severity. The presence of endometriomas had no impact on IVF clinical outcome. The optimal time to perform IVF appears to be between 7 and 25 months after endometriosis surgery.
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Affiliation(s)
- Basheer AlKudmani
- CReATe Fertility Centre, Toronto, Ontario, Canada; Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada
| | - Itai Gat
- CReATe Fertility Centre, Toronto, Ontario, Canada; Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada; Pinchas Borenstein Talpiot Medical Leadership Program, Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | | | | | - Khaled Zohni
- CReATe Fertility Centre, Toronto, Ontario, Canada; Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada
| | - Clifford Librach
- CReATe Fertility Centre, Toronto, Ontario, Canada; Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada; Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Gynecology, Women's College Hospital, Toronto, Ontario, Canada
| | - Prati Sharma
- CReATe Fertility Centre, Toronto, Ontario, Canada; Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada; Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Gynecology, Women's College Hospital, Toronto, Ontario, Canada
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Takashima A, Takeshita N, Kinoshita T. Pregnancy outcomes after assisted reproductive procedures with embryos that had been derived from affected and unaffected ovaries among women with small unilateral endometriomas. Reprod Med Biol 2017; 16:152-156. [PMID: 29259463 PMCID: PMC5661819 DOI: 10.1002/rmb2.12020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 12/20/2016] [Indexed: 11/09/2022] Open
Abstract
Aim To clarify the effects of small endometriomas on in vitro fertilization (IVF) outcomes. In the present study, the potential impact of small ovarian endometriomas on the quantitative and qualitative outcomes of IVF was evaluated in the same individual. Methods A retrospective analysis was performed, in which 118 infertile women with unilateral endometriomas that were <40 mm in size and who underwent IVF or intracytoplasmic sperm injection were evaluated. Single frozen embryo transfer cycles were performed, with separate data collections for both the affected and the unaffected ovaries, which allowed for an evaluation of the implantation rate. Results The mean antral follicular count and the number of follicular flushings, retrieved oocytes, and obtained embryos were significantly lower for the endometrioma‐containing ovary than for the contralateral, intact ovary. No significant difference was observed regarding the blastocyst retrieval and good‐quality blastocyst retrieval rates, pregnancy rate, and clinical pregnancy or live birth rate. Conclusion Although the patients with a small endometrioma had a decreased ovarian reserve, they had lower pregnancy rates. The decision to transfer an embryo from an endometrioma‐containing ovary or from a contralateral, intact ovary also might not influence the pregnancy rate.
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Affiliation(s)
- Akiko Takashima
- Department of Obstetrics and Gynecology Toho University Medical Center Sakura Hospital Sakura Japan
| | - Naoki Takeshita
- Department of Obstetrics and Gynecology Toho University Medical Center Sakura Hospital Sakura Japan
| | - Toshihiko Kinoshita
- Department of Obstetrics and Gynecology Toho University Medical Center Sakura Hospital Sakura Japan
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Maignien C, Santulli P, Gayet V, Lafay-Pillet MC, Korb D, Bourdon M, Marcellin L, de Ziegler D, Chapron C. Prognostic factors for assisted reproductive technology in women with endometriosis-related infertility. Am J Obstet Gynecol 2017; 216:280.e1-280.e9. [PMID: 27899313 DOI: 10.1016/j.ajog.2016.11.1042] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 11/21/2016] [Accepted: 11/21/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Assisted reproductive technology is one of the therapeutic options offered for managing endometriosis-associated infertility. Yet, published data on assisted reproductive technology outcome in women affected by endometriosis are conflicting and the determinant factors for pregnancy chances unclear. OBJECTIVE We sought to evaluate assisted reproductive technology outcomes in a series of 359 endometriosis patients, to identify prognostic factors and determine if there is an impact of the endometriosis phenotype. STUDY DESIGN This was a retrospective observational cohort study, including 359 consecutive endometriosis patients undergoing in vitro fertilization or intracytoplasmic sperm injection, from June 2005 through February 2013 at a university hospital. Endometriotic lesions were classified into 3 phenotypes-superficial peritoneal endometriosis, endometrioma, or deep infiltrating endometriosis-based on imaging criteria (transvaginal ultrasound, magnetic resonance imaging); histological proof confirmed the diagnosis in women with a history of surgery for endometriosis. Main outcome measures were clinical pregnancy rates and live birth rates per cycle and per embryo transfer. Prognostic factors of assisted reproductive technology outcome were identified by comparing women who became pregnant and those who did not, using univariate and adjusted multiple logistic regression models. RESULTS In all, 359 endometriosis patients underwent 720 assisted reproductive technology cycles. In all, 158 (44%) patients became pregnant, and 114 (31.8%) had a live birth. The clinical pregnancy rate and the live birth rate per embryo transfer were 36.4% and 22.8%, respectively. The endometriosis phenotype (superficial endometriosis, endometrioma, or deep infiltrating endometriosis) had no impact on assisted reproductive technology outcomes. After multivariate analysis, history of surgery for endometriosis (odds ratio, 0.14; 95% confidence ratio, 0.06-0.38) or past surgery for endometrioma (odds ratio, 0.39; 95% confidence ratio, 0.18-0.84) were independent factors associated with lower pregnancy rates. Anti-müllerian hormone levels <2 ng/mL (odds ratio, 0.51; 95% confidence ratio, 0.28-0.91) and antral follicle count <10 (odds ratio, 0.27; 95% confidence ratio, 0.14-0.53) were also associated with negative assisted reproductive technology outcomes. CONCLUSION The endometriosis phenotype seems to have no impact on assisted reproductive technology results. An altered ovarian reserve and a previous surgery for endometriosis and/or endometrioma are associated with decreased pregnancy rates.
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Guo H, Wang Y, Chen Q, Chai W, Lv Q, Kuang Y. Effect of Natural Cycle Endometrial Preparation for Frozen-Thawed Embryo Transfer in Patients with Advanced Endometriosis. Med Sci Monit 2016; 22:4596-4603. [PMID: 27889789 PMCID: PMC5126939 DOI: 10.12659/msm.898044] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background The aim of this study was to investigate the effect of natural cycle (NC) endometrial preparation for frozen-thawed embryo transfer (FET) in women with advanced endometriosis. Material/Methods This retrospective study included 179 patients with stage III–IV endometriosis who underwent 233 FET cycles at a tertiary care academic reproductive medical center between March 2011 and August 2013 (group A). The control group included 258 patients with tubal factor infertility who underwent 300 FET cycles (group B). Both groups were prepared for FET using a NC protocol. Rates of implantation, clinical pregnancy, live birth, ongoing pregnancy, miscarriage, and pregnancy complication were recorded. Results The implantation rate (A: 36.0%, B: 30.4%, P=0.06), the pregnancy rate (A: 50.2%, B: 45.3%, P=0.263), and the live birth rate (A: 39.91%, B: 39.0%, P=0.428) were similar between the stage III–IV endometriosis and tubal factor infertility groups. No differences were observed in ongoing rates of pregnancy, miscarriage, and pregnancy complications, independent of endometriosis severity. No congenital birth defects were found. When high-quality embryos are transferred, pregnancy results were not affected by active endometriosis. Although severe endometriosis did not affect birth rate, higher frequencies of premature delivery (mean gestational age A: 37 weeks, B: 38.3 weeks, P=0.044) and low birth weight were observed (<2500 g A: 26.4%, B: 16.6%, P=0.047). Conclusions There was no difference in pregnancy outcomes between patients with endometriosis and those with tubal infertility. Pregnancy outcomes in patients with endometriosis were not affected by endometriosis severity. Pregnancy outcomes were not affected by active endometrial cyst.
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Affiliation(s)
- Haiyan Guo
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai, China (mainland)
| | - Yun Wang
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai, China (mainland)
| | - Qiuju Chen
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai, China (mainland)
| | - Weiran Chai
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai, China (mainland)
| | - Qifeng Lv
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai, China (mainland)
| | - Yanping Kuang
- Department of Assisted Reproduction, Shanghai Ninth People's Hospital, Shanghai, China (mainland)
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de Lima CB, Cordeiro FB, Camargo M, Zylbersztejn DS, Cedenho AP, Bertolla RP, Lo Turco EG. Follicular fluid lipid peroxidation levels in women with endometriosis during controlled ovarian hyperstimulation. HUM FERTIL 2016; 20:48-54. [PMID: 27802789 DOI: 10.1080/14647273.2016.1246753] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
This observational study aimed to establishing a relationship between lipid peroxidation and endometriosis in women undergoing controlled ovarian hyperstimulation. A total of 79 women were divided into two groups: (i) controls (tubal or male factor); and (ii) endometriosis (stages III/IV). The endometriosis diagnosis was confirmed by videolaparoscopy and the controlled ovarian stimulation protocol was similar to all patients. Follicular fluid (FF) lipid peroxidation levels were determined through the quantification of malondialdehyde. Statistical analysis was performed using parametric and non-parametric tests, logistic regression was performed to estimate the chance of achieving a pregnancy in each group and a moving average was calculated for the endometriosis group. Peroxidation levels in the endometriosis group were significantly higher when compared to controls. The moving average showed a decrease of MDA levels in the endometriosis group with increasing female age. Moreover, women with endometriosis who were under 33 years of age were 4.3 times more likely to achieve a pregnancy than women above that age. In conclusion, endometriosis is associated with increased FF oxidative stress (OS) in patients undergoing in vitro fertilization (IVF). Also, increasing age is associated with a decrease in severity of the oxidative status, but a decreased chance of pregnancy.
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Affiliation(s)
- Camila Bruna de Lima
- a Department of Surgery, Division of Urology, Human Reproduction Section , Sao Paulo Federal University, Sao Paulo Hospital , Sao Paulo , Brazil
| | - Fernanda Bertuccez Cordeiro
- a Department of Surgery, Division of Urology, Human Reproduction Section , Sao Paulo Federal University, Sao Paulo Hospital , Sao Paulo , Brazil
| | - Mariana Camargo
- a Department of Surgery, Division of Urology, Human Reproduction Section , Sao Paulo Federal University, Sao Paulo Hospital , Sao Paulo , Brazil
| | - Daniel Suslik Zylbersztejn
- a Department of Surgery, Division of Urology, Human Reproduction Section , Sao Paulo Federal University, Sao Paulo Hospital , Sao Paulo , Brazil
| | - Agnaldo Pereira Cedenho
- a Department of Surgery, Division of Urology, Human Reproduction Section , Sao Paulo Federal University, Sao Paulo Hospital , Sao Paulo , Brazil
| | - Ricardo Pimenta Bertolla
- a Department of Surgery, Division of Urology, Human Reproduction Section , Sao Paulo Federal University, Sao Paulo Hospital , Sao Paulo , Brazil
| | - Edson Guimarães Lo Turco
- a Department of Surgery, Division of Urology, Human Reproduction Section , Sao Paulo Federal University, Sao Paulo Hospital , Sao Paulo , Brazil
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Shebl O, Sifferlinger I, Habelsberger A, Oppelt P, Mayer RB, Petek E, Ebner T. Oocyte competence in in vitro fertilization and intracytoplasmic sperm injection patients suffering from endometriosis and its possible association with subsequent treatment outcome: a matched case-control study. Acta Obstet Gynecol Scand 2016; 96:736-744. [PMID: 27317364 DOI: 10.1111/aogs.12941] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Accepted: 06/15/2016] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Endometriosis affects up to 15% of women of reproductive age. There is an obvious lack of studies dealing with morphological parameters of oocyte morphology in endometriosis patients in assisted reproduction. One aim of the study is to describe oocyte morphology in patients undergoing intracytoplasmic sperm injection suffering from endometriosis. In addition, the impact of endometriosis on in vitro fertilization results is analyzed. Both in vitro fertilization and intracytoplasmic sperm injection patients are then matched with an endometriosis-free control group for highlighting the possible association of endometriosis with pregnancy outcome. MATERIAL AND METHODS Oocyte morphology of endometriosis patients was assessed in two groups. Both study group and control group consisted of 129 in vitro fertilization/intracytoplasmic sperm injection cycles each. Patients were matched according to anti-Müllerian hormone, female age, previous treatment cycles, and method of fertilization. Endometriosis was graded according to the revised American Society for Reproductive Medicine guidelines of 1997. RESULTS Patients with endometriosis had a significantly lower rate of mature oocytes (p < 0.03) and morphologically normal oocytes (p < 0.001). In particular, brownish oocytes (p < 0.009; stage I-IV) and the presence of refractile bodies (p < 0.001; stage IV) were found to be increased. Endometriosis stage IV was associated with significantly worse-quality oocytes than stages I-III (p < 0.01). Fertilization was significantly reduced in conventional in vitro fertilization but not in intracytoplasmic sperm injection (p < 0.03). This was due to lower fertilization rates in stage III-IV endometriosis compared with stage I-II (p < 0.04). No difference was observed with respect to rates of implantation, clinical pregnancy, miscarriage, live birth, and malformation. CONCLUSIONS Endometriosis patients, in particular those with severe endometriosis, present lower-quality oocytes. Once fertilized, no impairment of further preimplantation embryo development and pregnancy outcome right up to healthy live birth rate has to be expected.
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Affiliation(s)
- Omar Shebl
- Department of Gynecology, Obstetrics, and Gynecological Endocrinology, Johannes Kepler University, Linz, Austria
| | | | - Alwin Habelsberger
- Department of Gynecology, Obstetrics, and Gynecological Endocrinology, Johannes Kepler University, Linz, Austria
| | - Peter Oppelt
- Department of Gynecology, Obstetrics, and Gynecological Endocrinology, Johannes Kepler University, Linz, Austria
| | - Richard B Mayer
- Department of Gynecology, Obstetrics, and Gynecological Endocrinology, Johannes Kepler University, Linz, Austria
| | - Erwin Petek
- Institute of Human Genetics, Medical University, Graz, Austria
| | - Thomas Ebner
- Department of Gynecology, Obstetrics, and Gynecological Endocrinology, Johannes Kepler University, Linz, Austria
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Rossi AC, Prefumo F. The effects of surgery for endometriosis on pregnancy outcomes following in vitro fertilization and embryo transfer: a systematic review and meta-analysis. Arch Gynecol Obstet 2016; 294:647-55. [PMID: 27300002 DOI: 10.1007/s00404-016-4136-4] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 06/07/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE To review the literature about the effect of endometriosis on in vitro-fertilization and embryo-transfer (IVF-ET). METHODS A search in EMBASE, MEDLINE, ClinicalTrial.gov, reference lists from 2000 to 2013 was conducted. Inclusion criteria were: endometriosis confirmed with histologic examination, women undergoing IVF-ET, endometriosis treated or diagnosed by surgery. Women undergoing IVF-ET after surgical removal of endometriosic implants, or a surgical diagnosis of endometriosis without its removal, were compared to women without endometriosis. Main outcomes were clinical pregnancy and delivery rates. RESULTS Thirteen studies were selected, including 980 women with endometriosis and 5934 controls. Clinical pregnancy rate was lower in women with endometriosis than in controls (OR 0.65; 95 % CI 0.44-0.96), but delivery rate was similar (OR 1.17; 95 % CI 0.69-1.98). When surgery was operative, clinical pregnancy rate after IVF-ET was lower in endometriosis than controls (OR 0.54; 95 % CI 0.34-0.85), but delivery rate was similar (OR 1.12; 95 % CI 0.60-2.07). When surgery was diagnostic, clinical pregnancy (OR 1.15; 95 % CI 0.46-2.84) and delivery rates (OR 1.65; 95 % CI 0.36-7.45) did not differ between the groups. Site of endometriosis was not related to IVF-ET outcomes. Clinical pregnancy rates were similar between stage I-II and controls (OR 0.99; 95 % CI 0.63-1.56) but lower in stage III-IV than controls (OR 0.45; 95 % CI 0.29-0.70), whereas delivery rate was not associated with stage. CONCLUSIONS In the presence of endometriosis, the clinical pregnancy rate after IVF-ET is lower than in controls. The prognosis is better for mild endometriosis compared with more advanced stages. Even after surgical removal of endometriosis, IVF-ET results remain worse than in controls.
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Affiliation(s)
- A Cristina Rossi
- Department of Obstetrics and Gynecology, Fabio Perinei Hospital, Bari, Italy
| | - Federico Prefumo
- Department of Obstetrics and Gynecology, University of Brescia, Piazzale Spedali Civili 1, 25123, Brescia, Italy.
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Xing W, Lin H, Wu Z, Li Y, Zhang Q. EFFECT OF PELVIC ENDOMETRIOSIS, ENDOMETRIOMAS AND RECURRENT ENDOMETRIOMAS ON IVF-ET/ICSI OUTCOMES. Mater Sociomed 2016; 28:91-4. [PMID: 27147911 PMCID: PMC4851495 DOI: 10.5455/msm.2016.28.91-94] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 03/12/2016] [Indexed: 11/13/2022] Open
Abstract
Introduction: Endometriosis, the most common gynecological disorder, is a challenging disease observed in 20% - 40% of subfertile women. Material and Methods: 380 women were divided into four groups. Group A consisted of 176 women with pelvic endometriosis. Group B consisted of 125 women who had previously undergone a laparoscopic endometrioma cystectomy. Group C consisted of 38 women with recurrent endometriomas without aspiration before IVF-ET/ICSI. Group D consisted of 41 women with recurrent endometriomas undergone aspiration before IVF-ET/ICSI. Results: Baseline FSH level (8.61 ± 3.42 mIU/mL) and total dose of Gn (2337.15 ± 853.00 IU) in Group A were the lowest (p < 0.05). The number of retrieved oocytes in Group B (7.98 ± 5.05) was significantly fewer than those in Group A and D (p < 0.05). The numbers of MII oocytes in Groups A, C and D were significantly larger than that in Group B. The number of retrieved oocytes, high-quality embryos, implantation and pregnancy rates were similar in Groups C and D. Conclusions: Pelvic endometriosis had a less adverse effect on ovarian reserve than endometrioma. No advantage was found in transvaginal aspiration for recurrent endometriomas before IVF-ET/ICSI.
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Affiliation(s)
- Weijie Xing
- Center for Reproductive Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Haiyan Lin
- Center for Reproductive Medicine, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zexuan Wu
- Center for Reproductive Medicine, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yu Li
- Center for Reproductive Medicine, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China
| | - Qingxue Zhang
- Center for Reproductive Medicine, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China
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Effect of Endometriosis on IVF Outcomes in Cases of Single Embryo Transfer for first IVF Attempt in Patients under 35. JOURNAL OF ENDOMETRIOSIS AND PELVIC PAIN DISORDERS 2016. [DOI: 10.5301/je.5000230] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background Implantation disorders are regarded differently in different groups undergoing in vitro fertilization (IVF) because of heterogeneous patient populations. To avoid this problem, this study was based solely on the first attempts of a single embryo transfer in patients under the age of 35. Methods This was a retrospective comparative study with 2 groups of patients: a group with endometriosis (n = 288) and a group without endometriosis (n = 1,368), registered from January 2010 to December 2013 in the IVF center of the University Hospital of Clermont-Ferrand. This study compared the 2 groups and subgroups according to ovarian response and embryo quality, and analyzed oocyte number, embryo number, transfer rate, implantation rate and delivery rate per ovum pick-up and per transfer. Results In the cases of endometriosis, the number of collected oocytes (8.37 ± 7.01 vs. 10.13 ± 6.53 p<0.001), the transfer rate (81.4% vs. 86.1%, p = 0. 045) and the rate of cycles with a frozen embryo (48.9% vs. 57.3%, p<0.01) were lower. The probability of a satisfactory response to stimulation (70.7% vs. 81.0%, p<0.001) and of a good quality embryo cohort (45% vs. 52%, p = 0.003) was lower. However, the implantation and delivery rates per transfer were not distorted in the cases of endometriosis, either in the total group or in any subgroup. The cumulative live birth rate per attempt was similar (29.2% vs. 29.5%). Conclusions Endometriosis has no impact on the embryo transfer in IVF, particularly when the embryo quality is satisfactory.
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Bastu E, Yasa C, Dural O, Mutlu MF, Celik C, Ugurlucan FG, Buyru F. Comparison of ovulation induction protocols after endometrioma resection. JSLS 2016; 18:JSLS-D-14-00128. [PMID: 25392665 PMCID: PMC4208901 DOI: 10.4293/jsls.2014.00128] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background and Objectives: The aim of this study was to compare the in vitro fertilization (IVF) outcomes of long gonadotropin-releasing hormone agonist (GnRH-a) and GnRH-antagonist (GnRH-ant) protocols in endometriosis patients who have undergone laparoscopic endometrioma resection surgery. To our knowledge, there is no study in the current literature that compares the effectiveness of long GnRH-a and GnRH-ant protocols in management of IVF cycles in endometriosis patients who underwent laparoscopic endometrioma resection surgery. Methods: Eighty-six patients with stage III to IV endometriosis who had undergone laparoscopic resection surgery for endometrioma were divided into 2 groups: those who had ovarian stimulation with a long GnRH-a protocol (n = 44), and those who had ovarian stimulation with a GnRH-ant protocol (n = 42). Results: The number of follicles on human chorionic gonadotropin injection day, duration of hyperstimulation, number of retrieved metaphase II oocytes, and total number of grade 1 embryos were statically significantly higher in the long GnRH-a protocol. There were no significant differences in positive β-human chorionic gonadotropin pregnancy rates (25% vs 21.4%; P = .269) and ongoing pregnancy rates per patient (20.5% vs 19.1%; P = .302) between the 2 protocols. Conclusions: Long GnRH-a and GnRH-ant protocols both present similar IVF outcomes in patients with endometriosis who have undergone laparoscopic endometrioma resection surgery. A long GnRH-a protocol may lead to a higher number of embryos that can be cryopreserved, providing the possibility of additional embryo transfers without having to go through the process of ovarian stimulation again.
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Affiliation(s)
- Ercan Bastu
- Department of Obstetrics and Gynecology, Istanbul University School of Medicine, Istanbul, Turkey
| | - Cenk Yasa
- Department of Obstetrics and Gynecology, Istanbul University School of Medicine, Istanbul, Turkey
| | - Ozlem Dural
- Department of Obstetrics and Gynecology, Istanbul University School of Medicine, Istanbul, Turkey
| | - Mehmet Firat Mutlu
- Department of Obstetrics and Gynecology, HRS Women Hospital, Kavaklidere, Ankara, Turkey
| | - Cem Celik
- Department of Obstetrics and Gynecology, Istanbul University School of Medicine, Istanbul, Turkey
| | - Funda Gungor Ugurlucan
- Department of Obstetrics and Gynecology, Istanbul University School of Medicine, Istanbul, Turkey
| | - Faruk Buyru
- Department of Obstetrics and Gynecology, Istanbul University School of Medicine, Istanbul, Turkey
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Antsiferova YS, Sotnikova NY. Apoptosis and endometrial receptivity: Relationship with in vitro fertilization treatment outcome. World J Obstet Gynecol 2016; 5:87-96. [DOI: 10.5317/wjog.v5.i1.87] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2015] [Revised: 09/28/2015] [Accepted: 12/02/2015] [Indexed: 02/05/2023] Open
Abstract
Apoptosis is an important process in the reconstruction of endometrium within the menstrual cycle. The balance between cell proliferation and apoptosis regulates the periodic repair and shedding of endometrial cells and leads to the menstruation or prepare the mucosal layer of endometrium for the implantation of the embryo. Many factors with pro- and antiapoptotic action, such as B cell lymphoma/leukemia-2 and inhibitors apoptosis proteins families, caspases, tumor necrosis factor receptors, phosphatase and tensin homolog, proliferator-activated receptor gamma, microRNAs and others are differently expressed in the endometrial tissue at phases of menstrual cycle. Receptivity of the endometrium at the period of “window of implantation” is associated with the significant increase of apoptosis in endometrium to allow the embryo to be successfully implanted. The impairment of apoptosis regulation in the endometrium at this period often is observed in infertile women with endometriosis, tubal factor, polycystic ovary syndrome, etc.. In many cases the impairment of apoptosis regulation in the endometrium is the main cause of in vitro fertilization (IVF) treatment failure in these patients. As of today, the exact mechanisms and factors mediating the apoptotic process in normal endometrium and in infertile women are not fully understood. Herein, the literature data concerning the endometrial apoptosis regulation in general, and in light of the influence of apoptosis upon IVF treatment outcome are reviewed. The possibility to use some parameters of endometrial apoptosis for prediction of the successful pregnancy achievement in women participating in IVF protocols also is discussed.
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Pop-Trajkovic S, Popović J, Antić V, Radović D, Stefanović M, Stavanovic M, Vukomanović P. Stages of endometriosis: does it affect in vitro fertilization outcome. Taiwan J Obstet Gynecol 2015; 53:224-6. [PMID: 25017272 DOI: 10.1016/j.tjog.2013.10.040] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2013] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE Women with endometriosis often need in vitro fertilization (IVF) to conceive. There are conflicting data on the results of IVF in patients with endometriosis. The present study was undertaken to investigate whether or not the stage of endometriosis affects the IVF outcome in order to give the best patient counseling MATERIALS AND METHODS We compared IVF outcome measures between 40 patients with surgically confirmed minimal and mild endometriosis (American Society for Reproductive Medicine Stage I/II) and 38 patients with moderate and severe endometriosis (Stage III/IV). Each group was also compared with a control group of 157 patients with tubal factor infertility. Outcome measures included number of follicles, number of oocytes, mean number of ampoules of gonadotropins, cumulative pregnancy, and live birth rates RESULTS Higher cancelation rates, higher total gonadotropin requirements, and lower oocyte yield were found in women with endometriosis Stage III and IV compared with both the Stage I/II and control groups. The fertilization rate was higher in Stage III/IV endometriosis compared to Stage I/II. Clinical pregnancy and live birth rates were comparable between patients with endometriosis Stage I/II and control group, whereas they were significantly lower in patients with endometriosis Stage III/IV compared to other two groups. CONCLUSION The American Society for Reproductive Medicine classification of endometriosis is useful in predicting IVF outcome. Advanced endometriosis means a worse prognosis for IVF treatment compared to milder stages or tubal factor infertility. The decreased fertilization rate in Stage I/II endometriosis might be a cause of subfertility in these women, as a result of a hostile environment caused by the disease.
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Affiliation(s)
| | - Jasmina Popović
- Clinic for Gynecology and Obstetrics, Clinical Center of Niš, Niš, Serbia
| | - Vladimir Antić
- Clinic for Gynecology and Obstetrics, Clinical Center of Niš, Niš, Serbia
| | - Dragana Radović
- Clinic for Gynecology and Obstetrics, Clinical Center of Niš, Niš, Serbia
| | - Milan Stefanović
- Clinic for Gynecology and Obstetrics, Clinical Center of Niš, Niš, Serbia
| | - Milan Stavanovic
- Clinic for Gynecology and Obstetrics, Clinical Center of Niš, Niš, Serbia
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Wahd SA, Alalaf SK, Al-Shawaf T, Al-Tawil NG. Ovarian reserve markers and assisted reproductive technique (ART) outcomes in women with advanced endometriosis. Reprod Biol Endocrinol 2014; 12:120. [PMID: 25442239 PMCID: PMC4266956 DOI: 10.1186/1477-7827-12-120] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Accepted: 11/26/2014] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND The role of ovarian reserve markers as predictors of the controlled ovarian stimulation (COS) response in intracytoplasmic sperm injection (ICSI) cycles in women with endometriosis has been much debated. The aim of the present study is to assess the predictability of ovarian reserve markers for the number of mature oocytes (MII) retrieved and to assess the pregnancy rate and live birth rate in women with advanced endometriosis. METHODS Two hundred eighty-five infertile women who had laparoscopy followed by a first ICSI cycle were recruited in this prospective study. One hundred ten patients were diagnosed with endometriosis stage III-IV (group 1), and 175 patients had no endometriosis (group II). Sixty-three patients in group 1 had no history of previous endometrioma surgery (group Ia), and 47 patients had a history of previous endometrioma surgery (group Ib). RESULTS The number of mature oocytes retrieved was significantly lower in women with advanced endometriosis than in women with no endometriosis. The number of mature oocytes retrieved in women with and without endometriosis was best predicted by antral follicle count (AFC) and age, whereas only AFC was a predictor in women with previous endometrioma surgery (odds ratio: 0.49; 95% confidence interval: 0.13-0.60). Women with endometriosis had a lower rate of live births than the control group, but this difference was not statistically significant; the number of live births was significantly lower in those with previous endometrioma surgery. CONCLUSIONS The best predictor of the COS response in ICSI was AFC, followed by age. Women receiving ICSI following surgery for ovarian endometrioma had a poorer clinical outcome and lower rate of live births compared with those with endometriosis but no previous surgery and the control group.
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Affiliation(s)
- Safiya A Wahd
- Department of Obstetrics and Gynecology, College of Medicine, Hawler Medical University, Erbil, Iraq
| | - Shahla K Alalaf
- Department of Obstetrics and Gynecology, College of Medicine, Hawler Medical University, Erbil, Iraq
| | - Talha Al-Shawaf
- Barts and The London Medical College, Women’s Health Research Unit, Centre for Primary Care and Public Health, Queen Mary University, London, UK
- Department of Primary Care and Public Health, Imperial College, London, UK
| | - Namir G Al-Tawil
- Department of Community Medicine, College of Medicine, Hawler Medical University, Erbil, Iraq
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van der Houwen LEE, Schreurs AMF, Schats R, Lambalk CB, Hompes PGA, Mijatovic V. Patient satisfaction concerning assisted reproductive technology treatments in moderate to severe endometriosis. Gynecol Endocrinol 2014; 30:798-803. [PMID: 24993503 DOI: 10.3109/09513590.2014.932341] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
A prospective observational cohort study was performed to examine patient satisfaction after one Assisted Reproductive Technology (ART) treatment cycle in moderate to severe endometriosis patients. From May 2012 till September 2013, 25 patients with surgically proven endometriosis stage III-IV were included per group and received intrauterine insemination (IUI), in vitro fertilization (IVF) or IVF preceded by long-term pituitary down-regulation (IVF-ultralong). The median patient satisfaction scores were 8.3, 7.9 and 8.0 in patients receiving IUI (n = 22), IVF (n = 24) and IVF-ultralong (n = 23), respectively (p = 0.89). Both deterioration in pain and quality-of-life could not be identified as determinants of decreased patient satisfaction scores. Satisfaction was higher in women receiving their first ART treatment attempt (p = 0.002), after treatment accomplishment (p = 0.04) and after a positive pregnancy test (p = 0.04). A median satisfaction score concerning preceding long term pituitary down-regulation of 6.1 (IVF-ultralong n = 25, IUI n = 8) was reported. Only three patients would refrain from this preceding therapy in a next treatment attempt. We concluded that patient satisfaction scores were comparable between the three different ART treatments. Since patient satisfaction was in particular dependent on treatment outcomes, it is recommended to compare those three ART treatments in a randomized controlled trial investigating the efficacy, safety and cost-effectiveness.
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Affiliation(s)
- Lisette E E van der Houwen
- Division of Reproductive Medicine, Department of Obstetrics and Gynaecology, Endometriosis Center, VU University Medical Center , Amsterdam , The Netherlands
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42
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Simerman AA, Hill DL, Grogan TR, Elashoff D, Clarke NJ, Goldstein EH, Manrriquez AN, Chazenbalk GD, Dumesic DA. Intrafollicular cortisol levels inversely correlate with cumulus cell lipid content as a possible energy source during oocyte meiotic resumption in women undergoing ovarian stimulation for in vitro fertilization. Fertil Steril 2014; 103:249-57. [PMID: 25439840 DOI: 10.1016/j.fertnstert.2014.09.034] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Revised: 09/23/2014] [Accepted: 09/23/2014] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To determine whether follicular fluid (FF) cortisol levels affect cumulus cell (CC) lipid content during oocyte meiotic resumption, and whether CCs express genes for glucocorticoid action. DESIGN Prospective cohort study. SETTING Academic medical center. PATIENT(S) Thirty-seven nonobese women underwent ovarian stimulation for in vitro fertilization (IVF). INTERVENTION(S) At oocyte retrieval, FF was aspirated from the first follicle (>16 mm in size) of each ovary and pooled CCs were collected. MAIN OUTCOME MEASURE(S) Follicular fluid cortisol and cortisone analysis was performed with the use of liquid chromatography-tandem mass spectrometry. CCs were stained with lipid fluorescent dye Bodipy FL C16 to determine lipid content with the use of confocal microscopy. Quantitative real-time polymerase chain reaction was used to detect CC gene expression of 11β-hydroxysteroid dehydrogenase (11β-HSD) types 1 and 2, glucocorticoid receptor (NR3C1), lipoprotein lipase (LPL), and hormone-sensitive lipase (HSL). RESULT(S) Adjusting for maternal age, FF cortisol levels negatively correlated with CC lipid content and positively correlated with numbers of total and mature oocytes. CCs expressed genes for 11β-HSD type 1 as the predominant 11β-HSD isoform, NR3C1, LPL, and HSL. CONCLUSION(S) FF cortisol levels may regulate CC lipolysis during oocyte meiotic resumption and affect oocyte quality during IVF.
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Affiliation(s)
- Ariel A Simerman
- Department of Obstetrics and Gynecology, University of California, Los Angeles, Los Angeles, California
| | - David L Hill
- ART Reproductive Center, Beverly Hills, California
| | - Tristan R Grogan
- Department of Medicine Statistics Core, University of California, Los Angeles, Los Angeles, California
| | - David Elashoff
- Department of Medicine Statistics Core, University of California, Los Angeles, Los Angeles, California
| | - Nigel J Clarke
- Quest Diagnostics Nichols Institute, San Juan Capistrano, California
| | - Ellen H Goldstein
- Department of Obstetrics and Gynecology, University of California, Los Angeles, Los Angeles, California
| | - Alexa N Manrriquez
- Department of Obstetrics and Gynecology, University of California, Los Angeles, Los Angeles, California
| | - Gregorio D Chazenbalk
- Department of Obstetrics and Gynecology, University of California, Los Angeles, Los Angeles, California
| | - Daniel A Dumesic
- Department of Obstetrics and Gynecology, University of California, Los Angeles, Los Angeles, California.
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43
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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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44
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Coccia ME, Rizzello F, Barone S, Pinelli S, Rapalini E, Parri C, Caracciolo D, Papageorgiou S, Cima G, Gandini L. Is there a critical endometrioma size associated with reduced ovarian responsiveness in assisted reproduction techniques? Reprod Biomed Online 2014; 29:259-66. [DOI: 10.1016/j.rbmo.2014.04.019] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Revised: 03/31/2014] [Accepted: 04/01/2014] [Indexed: 11/26/2022]
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45
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Bilibio JP, Souza CA, Rodini GP, Andreoli CG, Genro VK, de Conto E, Cunha-Filho JS. Serum Prolactin and CA-125 Levels as Biomarkers of Peritoneal Endometriosis. Gynecol Obstet Invest 2014; 78:45-52. [DOI: 10.1159/000362272] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Accepted: 03/16/2014] [Indexed: 11/19/2022]
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46
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Polat M, Boynukalın FK, Yaralı İ, Esinler İ, Yaralı H. Endometriosis Is Not Associated with Inferior Pregnancy Rates in in vitro Fertilization: An Analysis of 616 Patients. Gynecol Obstet Invest 2014; 78:59-64. [DOI: 10.1159/000360607] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Accepted: 02/12/2014] [Indexed: 11/19/2022]
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47
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Amin M, Simerman A, Cho M, Singh P, Briton-Jones C, Hill D, Grogan T, Elashoff D, Clarke NJ, Chazenbalk GD, Dumesic DA. 21-Hydroxylase-derived steroids in follicles of nonobese women undergoing ovarian stimulation for in vitro fertilization (IVF) positively correlate with lipid content of luteinized granulosa cells (LGCs) as a source of cholesterol for steroid synthesis. J Clin Endocrinol Metab 2014; 99:1299-306. [PMID: 24423334 PMCID: PMC3973780 DOI: 10.1210/jc.2013-3204] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Mineralocorticoid synthesis by the nonhuman primate periovulatory follicle enhances luteinization. Whether a similar event occurs in women undergoing in vitro fertilization (IVF) is unknown. OBJECTIVE The objective of the study was to determine whether human luteinized granulosa cells (LGCs) produce mineralocorticoids derived from 21-hydroxylase activity and also express mRNA for 21-hydroxylase and the mineralocorticoid receptor. DESIGN This was a prospective cohort study. SETTING The study was conducted at an academic center. PATIENTS LGC lipid content and follicle fluid (FF) hormone analysis was performed on 27 nonobese IVF women. LGCs from six additional nonobese IVF women were used for gene expression studies. INTERVENTION At oocyte retrieval, FF was aspirated from the first follicle (≥16 mm in size) of each ovary and pooled LGCs were collected. MAIN OUTCOME MEASURES FF steroid analysis was performed by liquid chromatography-tandem mass spectrometry. LGCs were stained with lipid fluorescent dye BODIPY FL C16 to estimate lipid content by confocal microscopy as a cholesterol source for steroidogenesis in vivo. Quantitative real-time PCR was performed using LGCs to detect 21-hydroxylase and mineralocorticoid receptor mRNA expression. Pearson correlation coefficients determined associations between FF steroid levels and LGC lipid content. RESULTS FF levels of the 21-hydroxylase-derived steroids, 11-deoxycorticosterone [DOC, 39.97, median (13.94-63.02) ng/mL] and 11-deoxycortisol [11DOC, 2.07 (0.69-5.01) ng/mL], along with the 21-hydroxylase precursor 17-hydroxyprogesterone [1268.21 (493.26-3558.39) ng/mL], positively correlated with LGC lipid content (84 ± 43 fluorescent units/sample) (P ≤ .05, all steroids). 21-Hydroxylase and mineralocorticoid receptor mRNA expression was detected in LGCs. CONCLUSIONS Human LGCs likely synthesize 21-hydroxylase-derived mineralocorticoids from cholesterol-containing lipid in vivo to promote postovulatory luteinization via mineralocorticoid receptor-mediated events.
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Affiliation(s)
- Marli Amin
- Department of Obstetrics and Gynecology (M.A., A.S., M.C., P.S., G.D.C., D.A.D.), David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California 90024; Department of Medicine Statistics Core (T.G., D.E.), David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, Los Angeles, California 90095; Quest Diagnostics Nichols Institute (N.J.C.), San Juan Capistrano, California 92675; and ART Reproductive Center (C.B.-J., D.H.), Beverly Hills, California 90210
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48
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AlSerri A, Kuriya A, Holzer H, Tulandi T. Lateralization of ovarian follicles. Gynecol Obstet Invest 2014; 77:117-20. [PMID: 24513727 DOI: 10.1159/000358395] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Accepted: 01/03/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIM To evaluate a possible lateralization of antral follicle count (AFC) based on the finding that endometriosis, if present, is more commonly found in the left hemipelvis. METHODS We evaluated the records of 6,617 baseline ultrasounds conducted at our Reproductive Center between 2007 and 2011 in a university teaching hospital setting. We included all ultrasounds with an AFC of 1 or greater and excluded those with incomplete documentation or with ovarian cyst, including endometriotic cysts (n = 909). The main outcome measure was the comparison of the number of antral follicles between the right and left ovary. RESULTS The number of antral follicles in the right ovary (median 18, range 15-22) was significantly higher than in the left ovary (median 16, range 13-20) among women with polycystic ovaries (PCO, AFC ≥24). Similarly, the number of antral follicles in the right ovary (median 8, range 6-10) was significantly higher than in the left ovary (median 7, range 5-9) in women with no PCO but normal ovarian reserve (AFC 10-23). CONCLUSIONS In women with PCO and non-PCO with normal ovarian reserve, the right ovary contains a higher number of antral follicles than the left ovary.
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Affiliation(s)
- Abdulrahman AlSerri
- Department of Obstetrics and Gynecology, McGill University, Montreal, Que., Canada
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49
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Efficacy and safety of IVF/ICSI in patients with severe endometriosis after long-term pituitary down-regulation. Reprod Biomed Online 2014; 28:39-46. [DOI: 10.1016/j.rbmo.2013.09.027] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Revised: 08/27/2013] [Accepted: 09/03/2013] [Indexed: 11/24/2022]
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50
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Singh AK, Chattopadhyay R, Chakravarty B, Chaudhury K. Altered circulating levels of matrix metalloproteinases 2 and 9 and their inhibitors and effect of progesterone supplementation in women with endometriosis undergoing in vitro fertilization. Fertil Steril 2013; 100:127-34.e1. [PMID: 23557756 DOI: 10.1016/j.fertnstert.2013.03.006] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2012] [Revised: 01/21/2013] [Accepted: 03/06/2013] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To investigate differences in the activity of matrix metalloproteinases (MMPs) 2 and 9 and their respective tissue inhibitors (TIMPs) in follicular fluid of women with endometriosis, to correlate the findings with IVF outcome, and to examine the therapeutic potential of progesterone supplementation in restoring the fine balance between MMPs and TIMPs. DESIGN Prospective case-control clinical study. SETTING Infertility clinic and reproductive health research unit. PATIENT(S) A total of 340 infertile women undergoing IVF. INTERVENTION(S) Natural micronized progesterone capsules were administered for luteal support. MAIN OUTCOME MEASURE(S) Association of MMPs 2 and 9 and TIMP-1 with oocyte maturity and embryo development. RESULT(S) An abnormal expression of MMP-2, MMP-9, and TIMP-1 with extensive MMP-9/TIMP-1 imbalance in women with endometriosis undergoing IVF was observed. Transforming growth factor β1 plays an important role in these women with possible involvement of Smad-2 and -3 proteins. Progesterone supplementation improves the imbalance in MMP-9/TIMP-1 ratio significantly in women with endometriosis who conceive after IVF. CONCLUSION(S) Increase in MMP-2 and -9 and decrease in TIMP-1 expression was associated with poor oocyte and embryo development in women with endometriosis undergoing IVF. MMP-9/TIMP-1 balance was highly affected in these women, and progesterone supplementation appeared to restore this imbalance to a considerable degree.
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Affiliation(s)
- Abhay Kumar Singh
- School of Medical Science and Technology, Indian Institute of Technology, Kharagpur, West Bengal, India
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