Goserelin followed by assisted reproduction: results in infertile women with endometriosis.

OBJECTIVE: Demonstrate the usefulness of combined treatment of a Gn-RH agonist and assisted reproduction in the management of infertile women with endometriosis. DESIGN: A prospective evaluation of goserelin's action (Gn-RH(a)) in the extension of endometriosis, of its suppression and clinical improvement, and in pregnancy rates after an immediate assisted reproduction program. SITE: Infertility clinic at a private hospital related to other university hospitals. PATIENTS: 18 infertile patients with laparoscopically-confirmed endometriosis. METHOD: All women were submitted to general laboratory tests, FSH, LH and estradiol measurements, and laparoscopy before and after treatment. All were treated for 6 months with goserelin and, when menstruating, the patients were submitted to an assisted reproduction program with a scheme of HMG + FSH + HCG. MAIN OUTCOME MEASURES: Improvement of endometriosis and achievement of pregnancy. RESULTS: An improvement of the endometriosis score was confirmed in 100% of the cases. The average pretreatment score of 44.8 points decreased to 18.3 after treatment. Similarly, the pain reported by eight of the patients practically disappeared after using the Gn-RH analogue. During treatment with goserelin, all women had amenorrhea. Their periods resumed in an average of 80.5 days after the last injection. In three (17.6%) cases, no follicular response was obtained, and stimulation was suspended. The remaining responses were good: eight GIFT procedures, four IVF-ET procedures and two IUIs resulted in eight pregnancies (57.1%), one of which terminated in an abortion (the patient became pregnant again). The eight pregnancies had good results: one was double and another quadruple. Most importantly, all pregnancies were achieved during the first treatment attempt. CONCLUSION: Combined treatment of goserelin with immediate assisted reproduction is a satisfactory procedure, which achieves a high percentage of pregnancies at the first try and with few abortions in cases of infertile women with endometriosis.