International symposium on immunopathogenesis of pregnancy December 6–7, 1997 American Hospital of Paris, 63, boulevard Victor–Hugo 92200 Neuilly–sur–Seine, France
- Book ID
- 101261945
- Publisher
- Hindawi Publishing Corporation
- Year
- 1997
- Tongue
- English
- Weight
- 58 KB
- Volume
- 5
- Category
- Article
- ISSN
- 1064-7449
No coin nor oath required. For personal study only.
✦ Synopsis
Objective: Endometriosis is a very common cause of infertility and often an indication for in vitro fertilization with embryo transfer (IVF-ET). When patients have severe endometriosis affecting the tubes, infertility is understandable. However, the mechanism of infertility with minimal or mild disease is unclear. Some authors have purported a decline in fecundity after IVF-ET in endometriosis patients in advanced stages of disease. 1 It has also been suggested that treatment of minimal or mild endometriosis in infertility patients who are attempting natural conception is beneficial. 2 The purpose of this study was to evaluate the effect of the presence of endometriosis and the stage of disease on IVF-ET outcome. Methods: 1417 consecutive cycles in 872 patients undergoing IVF-ET at The New York Hospital-Cornell Medical Center from 1989 to 1997 were analyzed in a retrospective study. Patients were identified by the presence of endometriosis as a diagnosis (primary, secondary or the presence of endometriosis) in a computer database. All charts were reviewed for the stage of endometriosis and classified according to ASRM. 3 Patients were treated with standard ovulation induction protocols and underwent IVF-ET according to previously published guidelines. Demographics, stimulation protocols and results, retrieval and transfer data, and pregnancy outcomes were analyzed. Clinical pregnancy was defined as the presence of a gestational sac. An ongoing pregnancy was defined as a pregnancy continuing beyond the 20th week of gestation. Analysis of variance, Chi square, and student's t-test were utilized when appropriate. P < 0.05 was considered significant. Results: 1196 (84.4%) of the 1417 initiated cycles went to retrieval. 1105/1196 (92.3%) underwent an embryo transfer. An overall clinical pregnancy rate/transfer of 44.7% (495/1105) and an overall ongoing pregnancy rate/transfer of 37.1% were noted. In analyzing all cycles that went to transfer, the stage of disease had no significant effect on peak estradiol levels, number of mature oocytes or embryos transferred, or pregnancy outcome. As expected, age was found to have a significant effect on IVF-ET outcome. Patients under 40 years old had a significantly higher clinical pregnancy rate/transfer than those 40 and over (48.4% vs. 31.8%; p < 0.001). To remove the effect of individual patients with multiple failed cycles and perhaps other unknown contributing causes of infertility, we next analyzed the first cycle of each patient with endometriosis. Once again, the stage of disease had no significant effect on peak estradiol levels, number of mature oocytes or embryos transferred, or pregnancy outcome. In analyzing the population by stimulation protocol, patients with lupreolide acetate down-regulated cycles were found to be younger, stimulate better, and had significantly higher clinical pregnancy rates (48.9% vs. 27.2%; P < 0.001). Given that patients with lupreolide acetate down-regulated cycles were found to have better outcomes, we than analyzed these patients to detect if stage of disease had any effect on IVF-ET outcome. In these patients, lower stages of endometriosis were associated with older women that stimulated better, had more oocytes retrieved, and had more embryos fertilized. Despite this, no differences in the ultimate number of embryos transferred or, more importantly, pregnancy outcomes were detected. We then analyzed the 741 cycles of patients with pure endometriosis as the only cause of infertility. In these patients, the stage of disease had no significant effect on peak estradiol levels, number of mature oocytes, number of embryos transferred, or preg-