IVF in patients with moderate and severe endometriosis

Abstract
A retrospective case control study analysing 64 IVF attempts included 22 patients with moderate (n = 4) or severe (n = 18) endometriosis, as defined by the revised American Fertility Society classification (1985), and 23 patients with tubal factor infertility. The diagnosis of endometriosis was confirmed by
at least visualization by laparoscopy or laparotomy and biopsies of typical lesions. An ovarian cystectomy had been performed in 13 patients (59%), an oophorectomy in three patients
(13.6%) and bilateral ovarian resection in one patient (4.5%). Tubal damage in the 23 control group patients was bilateral proximal tubal occlusion (n = 10), hydrosalpinx (n = 7),
bilateral salpingectomy for recurrent ectopic pregnancy (n = 3), monolateral idrosalpinx and proximal occlusion (n = 2) and tubal sterilization by bipolar coagulation (n = ‘I). The
groups were comparable by maternal age and duration of infertility. All patients received luteal phase GnRHa between cycle days 19 and 28. Stimulation with high purity FSH
(Metrodin; Serono) was started when there was no sonographic evidence of ovarian activity and serum oestradiol concentrations were <50 pg/ml. Then ovarian stimulation, oocyte
retrieval and embryo transfer were performed using a standard protocol. Positive pregnancies were defined as serum ~-HCG concentrations >5 mIU/ml 10 days after embryo transfer and
ultrasound evidence of a fetal heart beat. We observed a statistically significant difference between FSH doses received (4110 ± 3322 versus 2722 ± 780 IV) and cycle cancellation rate (12.5 versus 0.0%) between the endometriosis and tubal factor groups respectively. The number and maturity of the oocyte–cumulus complexes retrieved and fertilization rates were similar between the two groups (66.1 and 61.1 % respectively). Grading and the number of embryos transferred in each group were comparable. Pregnancy rates per transfer were
similar (17.3% for endometriosis and 19.2% for tubal factor). Our results confirm that in an IVF programme patients with severe endometriosis show a similar pregnancy rate to tubal factor patients despite ovarian responsiveness to exogenous gonadotrophin.

Autori: M. Mignini Renzini, N. Meroni, MB. Dal Canto, L. Ferrari, A. Villa, R. Fadini