Cycle-specific and cumulative fecundity in patients with endometriosis who are undergoing controlled ovarian hyperstimulation-intrauterine insemination or in vitro fertilization-embryo transfer

W. Paul Dmowski, Dmowski WP, Pry M, Michelle Pry, Ding J, Jianchi Ding, Rana N, Nasir Rana
Fertility and sterility · 2002 · vol. 78(4) , pp. 750–756 · doi:10.1016/s0015-0282(02)03343-5 · PMID:12372451 · W2062134481
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This study investigated the impact of endometriosis on fecundity in patients undergoing controlled ovarian hyperstimulation with intrauterine insemination or in vitro fertilization-embryo transfer, examining cycle-specific and cumulative pregnancy rates.

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Abstract

ObjectiveTo compare controlled ovarian hyperstimulation-intrauterine insemination (COH-IUI) or IVF-ET pregnancy rates per cycle (PR) and cycle and cumulative fecundity (f and cf) with COH-IUI or IVF-ET in endometriosis.DesignRetrospective analysis.SettingEndometriosis research institute.Patient(s)Women with endometriosis and infertility (n = 313) who underwent consecutive COH-IUI (202 patients, 648 cycles), IVF-ET (111 patients, 139 cycles), or IVF-ET after failed COH-IUI (56 patients, 68 cycles).Intervention(s)None.Main outcome measure(s)Crude PR and life table-estimated f and cf.Result(s)With COH-IUI, 69 patients conceived; 65 conceived with IVF-ET; and 30 conceived with IVF-ET after COH-IUI (PR 11%, 47%, and 44%). With COH-IUI, six-cycle cf was 41%, and f for cycles 1-6 was 15%, 12%, 8%, 7%, 7%, and 0. With IVF-ET, three-cycle cf was 73%, whereas f for cycles 1-3 was 47%, 27%, and 33%. First-cycle f with IVF-ET was significantly higher than cf of six COH-IUI cycles. When the data were stratified according to the stage of endometriosis and women's age, the benefit of IVF over COH was even more pronounced. Prior COH-IUI failure did not adversely affect IVF-ET outcome.Conclusion(s)In endometriosis, PR, f, and cf are significantly higher with IVF-ET than COH-IUI, especially in stage IV and in women >38 years of age. Considering adverse effects of prolonged ovarian stimulation on endometriosis, IVF-ET should be the first-line approach in the management of infertility in this disease. If COH-IUI is attempted, it should not exceed three to four cycles.

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Condition tags

endometriosis

MeSH descriptors

Embryo Transfer Endometriosis Fertilization in Vitro Infertility, Female Insemination, Artificial, Homologous Ovulation Induction Adult Chorionic Gonadotropin Chorionic Gonadotropin Cryopreservation Embryo Implantation Endometriosis Endometriosis Estradiol Estradiol Female Humans Infertility, Female Infertility, Female Pregnancy

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References (23)

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