Comparison of Management and Ovulation-Induction Protocols and Infertility Outcomes in Endometriosis

INTRODUCTION: Endometriosis is a well-established reason for infertility and optimal management and ovulation induction protocols in infertility patients with endometriosis are debated. Operative compared with conservative management with antagonist and agonist protocols for ovulation induction are compared. METHODS: One hundred sixty-four patients with endometriosis and endometriomas who were selected for assisted reproductive technology treatment were included. Patients' records were reviewed retrospectively. Eighty-eight patients were operated on who had endometriomas, whereas 76 patients were conservatively managed. In the operated group, 44 patients received antagonist protocol, whereas 43 patients were treated with an agonist protocol. In the conservatively managed group, 46 and 28 patients were treated with antagonist and agonist protocols, respectively. RESULTS: All groups were matched for age, body mass index, and duration of infertility. Operated compared with conservatively managed groups were not statistically different in dosage of gonadotropins used, follicle count, number of oocytes picked up, or clinical pregnancy rates. Subgroups that were treated either with an antagonist or an agonist protocol were statistically similar for follicle counts, total numbers of oocytes and embryos, and pregnancy rates. Primary and secondary infertility patients in either group were further investigated for the benefits of different ovulation induction regimens and analysis revealed no significant difference in follicles, oocytes picked up and embryos as well as pregnancy rates. CONCLUSION: Operatively and conservatively managed patients with endometriosis and endometriomas similarly benefit from antagonist and agonist protocols.