O-166 Alterations of stimulation in the face of endometriosis

Abstract Endometriosis is a common diagnosis in women with infertility. As IVF is increasingly being utilized as the most effective treatment for infertility, the implication of a prior endometriosis diagnosis on the ovarian stimulation portion of the process becomes of paramount importance. Early studies suggested pre-treatment with GnRH agonist improved pregnancy outcome. These studies were in a time when stimulation, retrieval, fertilization and culture, and transfer occurred in a single cycle. This was considered to improve “oocyte health” decreasing the inflammatory environment in which the follicle develops. However, increasingly, information has evolved about the impact of endometriosis on eutopic endometrium. So, the relevance of this treatment in the current model, whereby stimulation and transfer are frequently separated, has not be considered in detail. Other common dogma regarding the role of endometriosis in fertility, IVF and pregnancy are beginning to be questioned. In this presentation, we discuss the implication of endometriosis on all aspects of ovarian stimulation including pre-cycle evaluation and management and how these treatments may impact ovarian reserve and ovarian reserve assessment. We then discuss current data regarding benefits and potential risks of pre-treatment suppression. We will consider stimulation specifics and adjuvants and whether stimulation itself may have an impact on the progression of endometriosis. In a time when surgery, the prior mainstay of diagnosis and management for endometriosis, is performed less commonly, will non-invasive markers of endometriosis increase identification and treatment indications? Are there data that these treatments actually improve outcome of ovarian stimulation? How does endometriosis impact oocyte and embryo “quality”? Our goal is to harmonize data, as applied in modern fertility care, regarding endometriosis evaluation, treatment and impact on IVF outcome.