Endometriosis Should Be Suppressed for 6–12 Weeks before Frozen Embryo Transfer

In: 50 Big Debates in Reproductive Medicine · 2021 · pp. 106–108 · doi:10.1017/9781108986373.041 · W3217319376
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Patients with endometriosis-associated infertility have diminished IVF outcomes compared to those with other infertility causes.

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This chapter from a collection of reproductive medicine debates argues that endometriosis should be suppressed for six to twelve weeks prior to frozen embryo transfer to optimize clinical outcomes. The authors note that while various management options exist, assisted reproduction often yields diminished results in patients with endometriosis compared to those with tubal or unexplained infertility. They propose that long-term suppression, potentially via GnRH agonists or oral contraceptives, may improve the success rates of subsequent IVF cycles by creating a more favorable uterine environment. This paper is centrally about endometriosis — specifically addressing the pre-transfer medical management of endometriosis-associated infertility to enhance frozen embryo transfer outcomes.

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Abstract

Various management options exist for the treatment of endometriosis-associated infertility. These include medical treatment, surgical treatment and a combination of both. When these options fail to produce a pregnancy, assisted reproduction is resorted to, ranging from intrauterine insemination (IUI) for minimal and mild cases of endometriosis to IVF and ICSI for those who do not achieve a pregnancy with IUI and for more advanced cases [1]. However, the clinical outcomes of IVF in patients with endometriosis-associated infertility seem to be diminished in comparison to patients suffering from tubal or unexplained infertility.
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- 50 Big Debates in Reproductive Medicine - Series page - 50 Big Debates in Reproductive Medicine - Copyright page - Contents - Contributors - Foreword - Introduction - Section I Limits for IVF - Section II IVF Add-ons - Section III The Best Policy - 14A IVF Should Be First-Line Treatment for Unexplained Infertility of Two Years Duration - 14B IVF Should Be First-Line Treatment for Unexplained Infertility of Two Years Duration - 15A Single Embryo Transfer Should Be Performed in All IVF Cycles - 15B Single-Embryo Transfer Should Be Performed in All IVF Cycles - 16A The Freezing of All Embryos Should Be Used for All IVF Cycles - 16B The Freezing of All Embryos Should Be Used for All IVF Cycles - 17A Luteal-Phase Support Should Be Stopped at the Time of a Positive Pregnancy Test - 17B Luteal Phase Support Should Be Stopped at the Time of a Positive Pregnancy Test - 18A A Natural Cycle Is the Best Protocol for Frozen Embryo Replacement - 18B A Natural Cycle Is the Best Protocol for Frozen Embryo Replacement - 19A All Pregnancies Conceived by IVF Should Be Delivered by Caesarean Section - 19B All Pregnancies Conceived by IVF Should Be Delivered by Caesarean Section - 20A Endometriosis Should Be Suppressed for 6–12 Weeks before Frozen Embryo Transfer - 20B Endometriosis Should Be Suppressed for 6–12 Weeks before Frozen Embryo Transfer - 21A Infertile Patients with Endometriosis Benefit from Surgery - 21B Infertile Patients with Endometriosis Benefit from Surgery - 22A Intramural Fibroids Greater than 4 cm in Diameter Should Be Removed to Aid Fertility - 22B Intramural Fibroids Greater than 4 cm in Diameter Should Be Removed to Aid Fertility - 23A All Infertile Women with a Uterine Septum Should Have a Surgical Removal - 23B All Infertile Women with a Uterine Septum Should Have a Surgical Removal - Section IV Embryology - Section V Ethics and Statistics - Section VI Male-factor Infertility - Section VII Genetics - Section VIII Ovarian Stimulation - Section IX Hormones and the Environment - Index - References For from Section III - The Best Policy Published online by Cambridge University Press: 25 November 2021 Book contents - 50 Big Debates in Reproductive Medicine - Series page - 50 Big Debates in Reproductive Medicine - Copyright page - Contents - Contributors - Foreword - Introduction - Section I Limits for IVF - Section II IVF Add-ons - Section III The Best Policy - 14A IVF Should Be First-Line Treatment for Unexplained Infertility of Two Years Duration - 14B IVF Should Be First-Line Treatment for Unexplained Infertility of Two Years Duration - 15A Single Embryo Transfer Should Be Performed in All IVF Cycles - 15B Single-Embryo Transfer Should Be Performed in All IVF Cycles - 16A The Freezing of All Embryos Should Be Used for All IVF Cycles - 16B The Freezing of All Embryos Should Be Used for All IVF Cycles - 17A Luteal-Phase Support Should Be Stopped at the Time of a Positive Pregnancy Test - 17B Luteal Phase Support Should Be Stopped at the Time of a Positive Pregnancy Test - 18A A Natural Cycle Is the Best Protocol for Frozen Embryo Replacement - 18B A Natural Cycle Is the Best Protocol for Frozen Embryo Replacement - 19A All Pregnancies Conceived by IVF Should Be Delivered by Caesarean Section - 19B All Pregnancies Conceived by IVF Should Be Delivered by Caesarean Section - 20A Endometriosis Should Be Suppressed for 6–12 Weeks before Frozen Embryo Transfer - 20B Endometriosis Should Be Suppressed for 6–12 Weeks before Frozen Embryo Transfer - 21A Infertile Patients with Endometriosis Benefit from Surgery - 21B Infertile Patients with Endometriosis Benefit from Surgery - 22A Intramural Fibroids Greater than 4 cm in Diameter Should Be Removed to Aid Fertility - 22B Intramural Fibroids Greater than 4 cm in Diameter Should Be Removed to Aid Fertility - 23A All Infertile Women with a Uterine Septum Should Have a Surgical Removal - 23B All Infertile Women with a Uterine Septum Should Have a Surgical Removal - Section IV Embryology - Section V Ethics and Statistics - Section VI Male-factor Infertility - Section VII Genetics - Section VIII Ovarian Stimulation - Section IX Hormones and the Environment - Index - References Various management options exist for the treatment of endometriosis-associated infertility. These include medical treatment, surgical treatment and a combination of both. When these options fail to produce a pregnancy, assisted reproduction is resorted to, ranging from intrauterine insemination (IUI) for minimal and mild cases of endometriosis to IVF and ICSI for those who do not achieve a pregnancy with IUI and for more advanced cases [1]. However, the clinical outcomes of IVF in patients with endometriosis-associated infertility seem to be diminished in comparison to patients suffering from tubal or unexplained infertility. - Type - Chapter - Information - 50 Big Debates in Reproductive Medicine , pp. 106 - 108Publisher: Cambridge University PressPrint publication year: 2021 Sallam, HN, Garcia-Velasco, JA, Dias, S, Arici, A. Long-term pituitary down-regulation before in vitro fertilization (IVF) for women with endometriosis. Cochrane Database Syst Rev. 2006 Jan 25;(1):CD004635.CrossRefGoogle Scholar Senapati, S, Sammel, MD, Morse, C, Barnhart, KT. Impact of endometriosis on in vitro fertilization outcomes: an evaluation of the Society for Assisted Reproductive Technologies Database. Fertil Steril. 2016 July;106(1):164–71.CrossRefGoogle Scholar de Ziegler, D, Gayet, V, Aubriot, FX, et al. Use of oral contraceptives in women with endometriosis before assisted reproduction treatment improves outcomes. Fertil Steril. 2010 Dec;94(7):2796–9.CrossRefGoogle ScholarPubMed Georgiou, EX, Melo, P, Baker, PE, et al. Long-term GnRH agonist therapy before in vitro fertilisation (IVF) for improving fertility outcomes in women with endometriosis. Cochrane Database Syst Rev. 2019 Nov 20;2019(11).Google ScholarPubMed Van der Houwen, LEE, Lier, MCI, Schreurs, AMF, et al. Continuous oral contraceptives versus long-term pituitary desensitization prior to IVF/ICSI in moderate to severe endometriosis: study protocol of a non-inferiority randomized controlled trial. Hum Reprod Open. 2019 Feb 23;2019(1):hoz001.CrossRefGoogle ScholarPubMed Accessibility compliance for the HTML of this chapter is currently unknown and may be updated in the future. To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle. Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply. 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endometriosisinfertility

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