1. To operate or not to operate before IVF
treatment in women with endometriosis
Leonardo Matheus R. Pereira, MD¹,2; João Pedro J. Caetano,2, MD, PhD; Ana Luisa M Campos,2; Márcia Cristina F. Ferreira¹, MD,PhD; Márcia Mendonça Carneiro,MD, PhD¹
1. Department of Obstetrics and Gynecology, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil; 2. Prócriar Reproductive Medicine Center, Belo Horizonte, Brazil.
Introduction: Endometriosis affects 5 to 10% of women of reproductive age and the main clinical features are chronic pelvic pain and infertility. The best treatment options for infertile women with endometriosis remains to be established.
Objective: Evaluate wether surgery before IVF treatment in infertility due to endometriosis is beneficial as regarding the number of mature oocytes, number of embryos transferred and pregnancy rates when compared with patients with tubal factor infertility also treated with IVF.
Design: Retrospective observational study.
Patients and Methods: Retrospective observational study of 234 consecutive IVF cycles performed from January 2011 to July 2013 at Pró-criar Reproductive Medicine Center. Two groups were formed : I- endometriosis(n=98), and II- tubal factor(n=136).Group I was further divided into three groups according to ASRM classification into 1-endometriosis grade I / II ,2 endometriosis grade III / IV and 3-womens with clinically suspected endometriosis or endometriotic lesions detected by ultrasound or magnetic resonance image and who did not undergo surgery.Outcomes evaluated were female age, BMI, basal FSH , number of hMG ampoules used, length of controlled ovarian hyperstimulation (COH), number of mature oocytes obtained and fertilized, number of embryos transferred and clinical pregnancy rates. All patients gave written informed consent to the use of their data. Statistical analysis was carried out using SPSS 20.0 and p<0,05 was considered statistically significant.
Results: The clinical and laboratory outcomes evaluated did not show any significant differences between groups (Table 1). When clinical pregnancy rates between the subdivisions of the endometriosis group and between the group with tubal factor infertility were compared, there was no statistically significant difference (Table 2).
Table 1: Clinical and laboratory outcomes in women with endometriosis and tubal factor infertility.
Table 2: Clinical pregnancy rates in subdivided groups of endometriosis in comparison to the tubal factor group
Variable
Group I
Endometriosis
(mean SD)
Group II
Tubal factor
P value
Female age(yrs)
34,7 ± 3,8
34,9 ± 4,0
0,669*
BMI (Kg/m²)
24,0 ± 3,0
23,5 ± 3,0
0,896*
Basal FSH
8,8 ± 4,5
8,3 ± 5,5
0,794*
Infertility period(months)
37,9 ± 24,0
47,0 ± 38,1
0,212*
Percentage of patients in first IVF
47,2%
52,8%
0,819**
Total number hMG ampoules
32,0 ± 9,1
30,0 ± 8,6
0,533*
Length of COH
10,5 ± 1,8
11,4 ±3,6
0,371*
Number of oocytes obtained
8,1 ± 4,3
11,9 ± 9,3
0,193*
Number of mature oocytes
6,1 ± 3,3
8,1 ± 5,8
0,368*
Number of fertilized oocytes
4,9 ± 2,4
6,8 ± 5,8
0,132*
Numbers of embryos transferred
2,16 ± 0,5
2,10 ± 0,7
0,092*
Clinical pregnancy rate/cycle
43,1%
46,9%
0,182**
Pregnancy rate x Group
a x b
a x c
a x d
b x c
Tubal factor group(a) 46,9%
Endometriosis I/II(b) 44,4%
0,427
0,194
0,187
0,307
Endometriosis III/IV(c) 40,5%
No surgery group(d) 43,8%
* Mann-whitney test
** Chi square test
Chi square test
Conclusions: Women with endometriosis-associated infertility undergoing IVF respond as well as women with tubal-factor infertility in terms of number of mature oocytes, fertilization and pregnancy rates. Neither surgery nor ASRM endometriosis staging influenced outcomes in terms of clinical pregnancy rates.
IRB approval: This study was approved by our local Ethics Comittee number CEP/Mater Dei Hospital- Brasil - CAEE