The influence of endometriosis on the success of gamete intrafallopian transfer (GIFT)

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Endometriosis patients showed decreased ovarian response and oocyte retrieval, yet GIFT pregnancy success rates were comparable to controls due to the procedure's limited oocyte requirement.

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The study evaluated outcomes of gamete intrafallopian transfer (GIFT) in 108 GIFT cycles performed for an endometriosis indication, compared with 156 GIFT cycles performed for other disease indications, using controlled ovarian hyperstimulation with up to seven oocytes transferred and prepared sperm. Although women with endometriosis showed progressively reduced ovarian response and fewer retrieved oocytes with increasing endometriosis severity, clinical pregnancy rates (40.4%, 36.7%, 41.7%), multiple pregnancy rates (34.9%, 27.3%, 45.0%), and early pregnancy loss rates (27.0%, 18.2%, 30.0%) did not differ significantly across endometriosis severity categories or versus nonendometriosis after multivariable adjustment for age, tubal health, active endometriosis/endometriomas, oocyte number, and sperm quality. The authors note that because the number of oocytes needed for GIFT is limited, comparable pregnancy results were observed despite reduced ovarian response. This paper is centrally about endometriosis — it analyzes how endometriosis influences ovarian response and pregnancy outcomes after GIFT.

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Abstract

PurposeOur purpose was to evaluate the outcomes of gamete intrafallopian transfer (GIFT) therapy in patients with endometriosis.MethodsOne hundred eight GIFT cycles performed under the indication of endometriosis were compared to 156 GIFT cycles with indications of other disease entities. A maximum of seven oocytes was transferred into one or both fimbriate ends with prepared spermatozoa. Clinical pregnancy rates and outcomes were evaluated according to Mantel-Haenszel's chi-square test. Multiple logistic regression analysis was performed to determine factors influencing the success on pregnancy in the total treatment cycles.ResultsThe anthropological variables, such as age of patients, duration of infertility, and semen grading, were comparable in both groups. The responses to controlled ovarian hyperstimulation (COH) were progressively decreased while increasing the severity of endometriosis conditions such as nonendometriosis, mild-form endometriosis, and advanced-form endometriosis patients. However, there were no significant differences in the clinical pregnancy rates (40.4, 36.7, and 41.7%, respectively), multiple pregnancy rates (34.9, 27.3, and 45.0%, respectively), and early pregnancy loss rates (27.0, 18.2, and 30.0%, respectively). Multivariate statistics of pregnancy rates that adjusted the effects of patients' age, tubal health, presence of active endometriosis and/or endometriomas, number of oocytes transferred, and quality of sperm exhibited no statistical significance between endometriosis and nonendometriosis groups.ConclusionsOur data show that patients with records of endometriosis have both a decreased ovarian response to gonadotropin stimulation and a decreased number of retrieved oocytes. Since the number of oocytes needed for the GIFT procedure is limited, pregnancy results for patients in the study group were comparable with those for patients in the control group.
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Abstract

Purpose: Our purpose was to evaluate the outcomes of gamete intrafallopian transfer (GIFT) therapy in patients with endometriosis.

Methods

One hundred eight GIFT cycles performed under the indication of endometriosis were compared to 156 GIFT cycles with indications of other disease entities. A maximum of seven oocytes was transferred into one or both fimbriate ends with prepared spermatozoa. Clinical pregnancy rates and outcomes were evaluated according to Mantel-Haenszel’s chi-square test. Multiple logistic regression analysis was performed to determine factors influencing the success on pregnancy in the total treatment cycles.

Results

The anthropological variables, such as age of patients, duration of infertility, and semen grading, were comparable in both groups. The responses to controlled ovarian hyperstimulation (COH) were progressively decreased while increasing the severity of endometriosis conditions such as nonendometriosis, mild-form endometriosis, and advanced-form endometriosis patients. However, there were no significant differences in the clinical pregnancy rates (40.4, 36.7, and 41.7%, respectively), multiple pregnancy rates (34.9, 27.3, and 45.0%, respectively), and early pregnancy loss rates (27.0, 18.2, and 30.0%, respectively). Multivariate statistics of pregnancy rates that adjusted the effects of patients’ age, tubal health, presence of active endometriosis and/or endometriomas, number of oocytes transferred, and quality of sperm exhibited no statistical significance between endometriosis and nonendometriosis groups.

Conclusions

Our data show that patients with records of endometriosis have both a decreased ovarian response to gonadotropin stimulation and a decreased number of retrieved oocytes. Since the number of oocytes needed for the GIFT procedure is limited, pregnancy results for patients in the study group were comparable with those for patients in the control group. Similar content being viewed by others

References

Speroff L, Glass RH, Kase NG: Endometriosis.In Clinical Gynecologic Endocrinology and Infertility, L. Speroff (ed). Baltimore, Williams and Wilkins, 1994, pp 853–871 Wessels PH, Trumpelmann MD, Cronje HS, Grobler S, Oosthuizen AP, Hamlett DK: Cost-effectiveness of gamete intrafallopian transfer in comparison with induction of ovulation with gonadotropins in the treatment of female infertility: A clinical trial. Fertil Steril 1992;57:163–167 Mills MS, Eddowes HA, Cahill DJ, Fahy UM, Abuzeid MIM, McDermott A, Hull MGR: A prospective controlled study of in-vitro fertilization, gamete intra-fallopian transfer and intrauterine insemination combined with superovulation. Hum Reprod 1992;7:490–494 Chillick CF, Acosta AA, Garcia JE, Perera S, Van Uem JFHM, Rosenwaks Z, Jones HW Jr: The role of in vitro fertilization in infertile patients with endometriosis. Fertil Steril 1985;44:56–61 Matson PL, Yovich JL: The treatment of infertility associated with endometriosis by in vitro fertilization. Fertil Steril 1986;46:432–434 Simon C, Gutierrez A, Vidal A, de los Santos MJ, Tarin JJ, Remohi J, Pellicer A: Outcome of patients with endometriosis in assisted reproduction: results from in-vitro fertilization and oocyte donation. Hum Reprod 1994;9:725–729 Geber S, Paraschos T, Atkinson G, Margara R, Winston RML: Results of IVF in patients with endometriosis: The severity of the disease does not affect outcome, or the incidence of miscarriage. Hum Reprod 1995;10:1507–1511 Dmowski WP, Friberg J, Rana N, Papierniak C, Michalowska J, El-Roeiy A: The effect of endometriosis, its stage and activity, and of autoantibodies on in vitro fertilization and embryo transfer success rates. Fertil Steril 1995;63:555–562 Wardle PG, Mitchell JD, McLaughlin EA, Ray BD, McDermott A, Hull MGR: Endometriosis and ovulatory disorder: Reduced fertilization in vitro compared with tubal and unexplained infertility. Lancet 1985;2:236–239 Schmidt CL: Endometriosis: A reappraisal of pathogenesis and treatment. Fertil Steril 1985;44:157–173 Nakamura K, Oosawa M, Kondou I, Inagaki S, Shibata H, Narita O, Suganuma N, Tomoda Y: Menotropin stimulation after prolonged gonadotropin releasing hormone agonist pretreatment for in vitro fertilization in patients with endometriosis. J Assist Reprod Genet 1992;9:113–117 Dicker D, Feldberg D, Goldman JA, Ashkenazi J, Levy T: The impact of long-term gonadotropin-releasing hormone analogue treatment on preclinical abortions in patients with severe endometriosis undergoing in vitro fertilization-embryo transfer. Fertil Steril 1992;57:597–600 Abramovici H, Dirnfeld M, Bornstein J, Lissak A, Gonen Y: Gamete intrafallopian transfer. An overview. J Reprod Med 1993;38:698–702 Asch RH: GIFT: Indications, results, problems, and perspectives. In Capitanio GL et al, editors: GIFT: From Basics to Clinics, Serono Symposia, Vol 63, EL Capitanioet al. (ed). New York, Raven Press, 1989 Guzick DS, Stovall DW, Yao YAS, Kubik CJ, Berga SL, Zeleznik AJ, Krasnow JS: Endometriosis impairs the efficacy of gamete intrafallopian transfer: Results of a case-control study. Fertil Steril 1994;62:1186–1191 American Fertility Society: Revised American Fertility Society classification of endometriosis. Fertil Steril 1985;43:351–354 Veeck LL: Atlas of the Human Oocyte and Early Conceptus. Baltimore, Williams & Wilkins, 1986 Author information Authors and Affiliations Rights and permissions About this article Cite this article Chang, MY., Chiang, CH., Hsieh, TT. et al. The influence of endometriosis on the success of gamete intrafallopian transfer (GIFT). J Assist Reprod Genet 14, 76–82 (1997). https://doi.org/10.1007/BF02765774 Received: Accepted: Issue date: DOI: https://doi.org/10.1007/BF02765774

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Condition tags

endometriosis

MeSH descriptors

Endometriosis Gamete Intrafallopian Transfer Gamete Intrafallopian Transfer Analysis of Variance Anthropometry Case-Control Studies Endometriosis Female Humans Logistic Models Multivariate Analysis Pregnancy Pregnancy Outcome Pregnancy Rate Retrospective Studies

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