Transvaginal ultrasonic needle-guided aspiration of endometriotic cysts before ovulation induction for in vitro fertilization

D Dicker, Dicker D, Dov Dicker, Goldman JA, Jack A. Goldman, J A Goldman, Dov Feldberg, Feldberg D, D Feldberg, Ashkenazi J, Jacob Ashkenazi, J Ashkenazi, Levy T, Tally Levy, T Levy
Journal of in vitro fertilization and embryo transfer : IVF · 1991 · vol. 8(5) , pp. 286–289 · doi:10.1007/bf01139786 · PMID:1757743 · W2002484329
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Transvaginal needle aspiration of endometriotic cysts before ovulation induction improved oocyte retrieval, embryo transfer, and clinical pregnancy rates in women undergoing IVF.

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The paper studied 41 women with endometriomata who had failed to conceive in prior IVF-ET cycles, comparing an approach in which endometriotic cysts were transvaginally aspirated using ultrasonic needle guidance immediately before ovulation induction versus the prior IVF experience. After aspiration, the authors reported significantly more oocytes recovered, more embryos transferred, and higher clinical pregnancy rates per cycle. They attribute these improvements to reduction of extensive ectopic endometrial tissue leading to improved ovarian response, follicular accessibility, and possibly oocyte quality, but the study’s design compares outcomes across protocols for the same cohort rather than randomizing to a concurrent control group. This paper is centrally about endometriosis — transvaginal ultrasonic needle-guided aspiration of endometriotic cysts before IVF ovulation induction.

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Abstract

Controversy still exists concerning the optimal treatment of endometriomata in endometriosis and its related infertility. Forty-one women with endometriomata who failed to conceive during previous in vitro fertilization and embryo transfer (IVF-ET) cycles (protocol A) were readmitted for ovum pickup following transvaginal ultrasonic needle-guided aspiration of the endometriomata (protocol B). Following aspiration a significantly higher number of oocytes was recovered (P less than 0.0006); subsequently, more embryos were transferred, and significantly higher clinical pregnancy rates per cycle (P less than 0.0001) were achieved. This difference may be directly related to the reduction of extensive ectopic endometrial tissue (endometriomata) with improved ovarian response, follicular accessibility, and, most probably, improved oocyte quality.
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Abstract

Controversy still exists concerning the optimal treatment of endometriomata in endometriosis and its related infertility. Forty-one women with endometriomata who failed to conceive during previous in vitro fertilization and embryo transfer (IVF-ET) cycles (protocol A) were readmitted for ovum pickup following transvaginal ultrasonic needle-guided aspiration of the endometriomata (protocol B). Following aspiration a significantly higher number of oocytes was recovered (P<0.0006); subsequently, more embryos were transferred, and significantly higher clinical pregnancy rates per cycle (P<0.0001) were achieved. This difference may be directly related to the reduction of extensive ectopic endometrial tissue (endometriomata) with improved ovarian response, follicular accessibility, and most probably, improved oocyte quality. Similar content being viewed by others

References

Chillik C, Acosta AA, Garcia JE, Perera S, Van Uem JF, Rosenwaks Z, Jones HW, Jr: The role of in vitro fertilization in infertile patients with endometriosis. Fertil Steril 1985;44:56–59 Matson PL, Yovich JL: The treatment of infertility associated with endometriosis by in vitro fertilization. Fertil Steril 1986;46:432–436 Oehninger S, Acosta AA, Kreiner D, Muasher SJ, Jones HW Jr, Rosenwaks Z: In vitro fertilization and embryo transfer (IVF-ET): An established and successful therapy for endometriosis. J Vitro Fertil Embryo Transfer 1988; 5:249–256 Dicker D, Goldman GA, Ashkenazi J, Feldberg D, Voliovitch I, Goldman JA: The value of pre-treatment with gonadotrophin releasing hormone (GnRH) analogue in IVF-ET therapy of severe endometriosis. Hum Reprod 1990;5:418–420 Feichtinger W, Kemeter P: Transvaginal sector scan sonography for needle guided transvaginal follicle aspiration and other applications in gynecological routine and research. Fertil Steril 1986;45:722–726 Feichtinger W, Kemeter P: Conservative treatment of ectopic pregnancy by transvaginal aspiration under sonographic control and methotrexate injection. Lancet 1987;1:381–382 Berkowitz RL, Lynch L, Chitkara V, Wilkin IA, Mehalek KE, Alvarez E: Selective reduction of multiple pregnancies in the first trimester. N Engl J Med 1988;318:1043–1046 Feldberg D, Ashkenazi J, Dicker D, Yeshaya A, Voliovitch I, Goldman J: Ovarian cyst aspiration during IVF-ET cycles. J Vitro Fertil Embryo Transfer 1988;5:372–375 Feldberg D, Goldman J, Shelef M, Ashkenazi J, Dicker D, Yeshaya A: Comparison of a fixed and dynamic protocol for embryo transfer in an IVF-ET program. Hum Reprod 1988;3:747–750 Feldberg D, Goldman JA, Ashkenazi J, Shelef M, Dicker D, Samuel N: Transvaginal oocyte retrieval controlled by vaginal probe for IVF, a comparative study. J Ultrasound Med 1988;7:339–343 Veeck LL, Wortham JWE Jr, Witmyer J, Sandow BA, Acosta AA, Garcia JE, Jones GS, Jones HW Jr: Maturation and fertilization of morphologically immature human oocytes in a program of in vitro fertilization Fertil Steril 1983;39:594–602 Beyth Y, Winston RML: Ovum capture and fertility following microsurgical fimbriectomy in the rabbit. Fertil Steril 1981;35:464–466 McCornb P, Delbeke L: Decreasing number of ovulations in the rabbit with surgical division of the blood vessels between the fallopian tube and ovary. J Reprod Med 1984;29:827–831 Molloy D, Martin M, Speirs A, Lopata A, Clarke G, McBain J, Ngv A, Johnston IH: Performance of patients with a “frozen pelvis” in an in vitro fertilization program. Fertil Steril 1987;47:450–455 Edwards RG, Steptoe PC: Current status of in vitro fertilization. Lancet 1983;2:1265–1269 Medical Research International and the Society of Assisted Reproductive Technology, The American Fertility Society: In vitro fertilization embryo transfer in the United States: 1987 results from the National IVF-ET Registry. Fertil Steril 1989;51:13–19 Author information Authors and Affiliations Rights and permissions About this article Cite this article Dicker, D., Goldman, J.A., Feldberg, D. et al. Transvaginal ultrasonic needle-guided aspiration of endometriotic cysts before ovulation induction for in vitro fertilization. J Assist Reprod Genet 8, 286–289 (1991). https://doi.org/10.1007/BF01139786 Received: Accepted: Issue date: DOI: https://doi.org/10.1007/BF01139786

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Condition tags

endometriosis

MeSH descriptors

Cysts Endometriosis Fertilization in Vitro Inhalation Ovulation Induction Cysts Cysts Endometriosis Endometriosis Endometrium Endometrium Female Humans Infertility, Female Infertility, Female Ovulation Induction Ultrasonography Vagina Vagina

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