Determining the Fertility Benefit of Controlled Ovarian Hyperstimulation With Intrauterine Insemination After Operative Laparoscopy in Patients With Endometriosis

Anjalika Gandhi, Anjalika R Gandhi, Gandhi AR, Luiz Fernando Carvalho, Carvalho LF, Luiz Fernando Pina Carvalho, Nutter B, Benjamin Nutter, Falcone T, Tommaso Falcone
Journal of Minimally Invasive Gynecology · 2013 · vol. 21(1) , pp. 101–108 · doi:10.1016/j.jmig.2013.07.009 · PMID:23911563 · W2155498418
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This study investigated the fertility benefit of controlled ovarian hyperstimulation with intrauterine insemination after operative laparoscopy in endometriosis patients.

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Abstract

Study objectiveTo determine the fertility benefit of controlled ovarian hyperstimulation (COH) and intrauterine insemination (IUI) in surgically treated endometriosis.DesignRetrospective cohort study (Canadian Task Force classification II-2).SettingCleveland Clinic Foundation, tertiary care center.PatientsNinety-six women of reproductive age who underwent operative laparoscopy to treat endometriosis-related infertility (endometriosis stage I/II n = 67; stage III/IV n = 29) from 2001 to 2011 at the Cleveland Clinic Foundation.InterventionsCOH via letrozole, clomiphene, or gonadotropins, with or without IUI.Measurements and main resultsKaplan-Meier estimations of cumulative pregnancy rates were compared by stage between COH/IUI and spontaneous cycles. Patients with stage I/II endometriosis attempted spontaneous pregnancy for 669 months and 216 COH + IUI cycles, and patients with stage III/IV endometriosis attempted spontaneous pregnancy for 379 months and 74 COH + IUI cycles. Crude pregnancy rates were 45.7% in stage I/II and 40.5% in stage III/IV. Twelve-month cumulative pregnancy rates in stage I/II were 45% for spontaneous attempts and 42% for COH + IUI, and in stage III/IV were 20% for spontaneous attempts and 10% for COH + IUI (not significant). Cumulative pregnancy rates for COH/IUI in stage I/II were significantly higher than in stage III/IV. Monthly fecundity rates were 3.81% for stage I/II spontaneous, 4.59% for COH/IUI, 3.05% for stage III/IV spontaneous, and 1.68% for COH/IUI (not significant).ConclusionsCOH + IUI did not improve pregnancy rates in any stage of endometriosis. In stage III/IV we recommend postoperative in vitro fertilization.

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Condition tags

endometriosis

MeSH descriptors

Endometriosis Infertility, Female Insemination, Artificial Ovulation Induction Adult Endometriosis Female Humans Infertility, Female Infertility, Female Laparoscopy Pregnancy Pregnancy Rate Retrospective Studies

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