DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20190495

Pregnancy and live birth rates in women with endometriosis related infertility in Latvia

Jekaterina Avdotina, Aleksandra Mezecka-Oleinika, Vija Silina, Zane Vitina

Abstract


Background: Women with endometriosis experience painful symptoms and/or infertility, others have no symptoms at all. According to European Society of Human Reproduction and Embryology guidelines, surgery and assisted reproductive technologies (ART) are an appropriate treatment in cases of endometriosis-associated infertility. There are controversial data on the results of surgery and ART in patients with endometriosis.

Methods: Retrospective analysis including 99 infertile patients aged between 25 and 48 years old. All of them had laparoscopic surgery as the primary option. 51 of them undergoing in vitro fertilization or intracytoplasmic sperm injection or frozen embryo transfer from 2003 through 2018 at SIA ‘Clinic EGV’.

Results: The mean age of women was 34.2±4.5. In 56 (33.5%) cases was only surgery with 28 (50.9%) biochemical pregnancies and 26 (48.1%) live birth. In 111 (66.5%) cases there were surgery with ART with 48 (47.6%) biochemical pregnancies and 23 (22.7%) live birth. In 1 group patients mean age 30.7±4.6 and 2 group with mean age 35.1±4.2 (p=0.000). It was found that there is significant difference between endometriosis phenotype, infertility type, duration of infertility, repeated laparoscopic surgery, ART cycles, retrieved oocyte count and biochemical pregnancy rate.

Conclusions: Patients with endometriosis related infertility should undergo surgical treatment as the primary option. Those patients who do not become pregnant after surgery must be treated with assisted reproductive technology. The optimal time to perform ART is first year after endometriosis surgery.


Keywords


Assisted reproductive technologies, Biochemical pregnancy, Endometriosis phenotypes, Endometriosis stage, Live birth, Surgery

Full Text:

PDF

References


Kennedy S, Bergqvist A, Chapron C, D'Hooghe T, Dunselman G, Greb R, et al. ESHRE guideline for the diagnosis and treatment of endometriosis. Hum Reprod. 2005;20:2698-704.

Eskenazi B, Warner ML. Epidemiology of endometriosis. Obstet Gynecol Clin North Am. 1997;24:235-58.

Meuleman C, Vandenabeele B, Fieuws S, Spiessens C, Timmerman D, D'Hooghe T. High prevalence of endometriosis in infertile women with normal ovulation and normospermic partners. Fertil Steril. 2009;92:68-74.

de Ziegler D, Borghese B, Chapron C. Endometriosis and infertility: pathophysiology and management. Lancet. 2010;376:730-8.

Johnson NP, Hummelshoj L, Adamson GD, Keckstein J, Taylor HS, Abrao MS, et al. World Endometriosis Society consensus on the classification of endometriosis. Hum Reprod. 2017;32(2):315-24.

Jacobson TZ, Duffy JM, Barlow DH, Farquhar C, Koninckx PR, Olive D. Laparoscopic surgery for subfertility associated with endometriosis. Cochrane Database of Systematic Reviews. 2010(1):CD001398.

Shimizu Y, Takashima A, Takahashi K, Kita N, Fujiwara M, Murakami T. Long‐term outcome, including pregnancy rate, recurrence rate and ovarian reserve, after laparoscopic laser ablation surgery in infertile women with endometrioma. J Obstet Gynaecol Res. 2010;36(1):115-8.

Omland AK, Åbyholm T, Fedorcsák P, Ertzeid G, Oldereid NB, Bjercke S, et al. Pregnancy outcome after IVF and ICSI in unexplained endometriosis-associated and tubal factor infertility. Hum Reprod. 2005;20:722-7.

Stephansson O, Kieler H, Granath F, Falconer H. Endometriosis, assisted reproductive technology, and risk of adverse pregnancy outcome. Hum Reprod. 2009;24:2341-7.

Zhang X, Liu D, Huang W, Wang Q, Feng X, Tan J. Prediction of Endometriosis Fertility Index in patients with endometriosis-associated infertility after laparoscopic treatment. Reprod Biomed Online. 2018;37(1):53-59.

Ramirez KH. Comparisons between laparoscopy only versus in vitro fertilization in combination with laparoscopy for increasing probability of pregnancy in patients with endometriosis associated infertility. School of Physician Assistant Studies; 2012(274). Available at: http://commons.pacificu.edu/pa/274.

Guideline on the management of women with endometriosis, 2013. Available at: https://www.eshre.eu/Guidelines-and-Legal/Guidelines/Endometriosis-guideline

Hamdan M, Omar SZ, Dunselman G, Cheong Y. Influence of endometriosis on assisted reproductive technology outcomes: a systematic review and meta-analysis. Obstet Gynecol. 2015;125:79-88.

Kuivasaari P, Hippelainen M, Anttila M, Heinonen S. Effect of endometriosis on IVF/ICSI outcome: stage III/IV endometriosis worsens cumulative pregnancy and live-born rates. Hum Reprod. 2005;20:3130-5.

Polat M, Boynukalin FK, Yarali I, Esinler I, Yarali H. Endometriosis is not associated with inferior pregnancy rates in in vitro fertilization: an analysis of 616 patients. Gynecol Obstet Invest. 2014;78:59-64.

Singh N, Lata K, Naha M, Malhotra N, Tiwari A, Vanamail P. Effect of endometriosis on implantation rates when compared to tubal factor in fresh non donor in vitro fertilization cycles. J Hum Reprod Sci. 2014;7:143-7.

Elsevier Science Inc. Revised American Society for Reproductive Medicine classification of endometriosis: 1996. Fertility and Sterility. 1997;67(5). Available at: https://doi.org/10.1016/S0015-0282(97)81391-X.

Nisolle M, Donnez J. Peritoneal endometriosis, ovarian endometriosis, and adenomyotic nodules of the rectovaginal septum are three different entities. Fertil Steril. 1997;68:585-96.

Agnani G, Collin A, Dellis X, Lagré P, Souquet C, Roux C. Endometriosis severity and IVF outcome. Fertil Steril. 2008;90:S408.

Maignien C, Santulli P, Gayet V, Lafay-Pillet MC, Korb D, Bourdon M, et al. Prognostic factors for assisted reproductive technology in women with endometriosis-related infertility. Am J Obstet Gynecol. 2017;216(3):280-e1.

Rossi AC, Prefumo F. The effects of surgery for endometriosis on pregnancy outcomes following in vitro fertilization and embryo transfer: a systematic review and meta-analysis. Arch Gynecol Obstet. 2016;294:647-55.

Barbosa MA, Teixeira DM, Navarro PA, Ferriani RA, Nastri CO, Martins WP. Impact of endometriosis and its staging on assisted reproduction outcome: systematic review and meta-analysis. Ultrasound Obstet Gynecol. 2014;44:261-78.

Jacobson TZ, Duffy JM, Barlow D, Farquhar C, Koninckx PR, Olive D. Laparoscopic surgery for subfertility associated with endometriosis. Cochrane Database Syst Rev. 2010:CD001398.

Nowroozi K, Chase JS, Check JH, Wu CH. The importance of laparoscopic coagulation of mild endometriosis in infertile women. Int J Fertil, 1987;32:442-4.

Nezhat C, Crowgey S, Nezhat F. Videolaseroscopy for the treatment of endometriosis associated with infertility. Fertil Steril. 1989;51:237-40.

Vercellini P, Fedele L, Aimi G, De Giorgi O, Consonni D, Crosignani PG. Reproductive performance, pain recurrence and disease relapse after conservative surgical treatment for endometriosis: the predictive value of the current classification system. Hum Reprod. 2006;21:2679-85.

Benaglia L, Somigliana E, Santi G, Scarduelli C, Ragni G, Fedele L. IVF and endometriosis-related symptom progression: insights from a prospective study. Hum Reprod. 2011;26:2368-72.

Coccia ME, Rizzello F, Gianfranco S. Does controlled ovarian hyperstimulation in women with a history of endometriosis influence recurrence rate? J Womens Health, 2010;19:2063-9.

AlKudmani B, Gat I, Buell D, Salman J, Zohni K, Librach C, et al. In vitro fertilization success rates after surgically treated endometriosis and effect of time interval between surgery and in vitro fertilization. J Minimally Invasive Gynecol. 2018;25(1):99-104.

Nesbitt-Hawes EM, Campbell N, Maley PE, Won H, Hooshmand D, Henry A, et al. The surgical treatment of severe endometriosis positively affects the chance of natural or assisted pregnancy postoperatively. BioMed Res Int. 2015;2015.

Bedaiwy MA, Falcone T, Katz E, Goldberg JM, Assad R, Thornton J. Association between time from endometriosis surgery and outcome of in vitro fertilization cycles. J Reprod Med. 2008;53:161-5.

Huang XW, Qiao J, Xia EL, Ma YM, Wang Y. Effect of interval after surgery on in vitro fertilization/ intracytoplasmic sperm injection outcomes in patients with stage III/IV endometriosis. Chin Med J. 2010;123:2176-80.

Barri PN, Coroleu B, Tur R, Barri-Soldevila PN, Rodríguez I. Endometriosis-associated infertility: surgery and IVF, a comprehensive therapeutic approach. Reprod Biomed Online. 2010;21(2):179-85.

Erdem A, Erdem M, Atmaca S, Korucuoglu U, Karabacak O. Factors affecting live birth rate in intrauterine insemination cycles with recombinant gonadotrophin stimulation. Reprod Biomed Online. 2008;17:199-206.

Nuojua-Huttunen S, Tomas C, Bloigu R, Tuomivaara L, Martikainen H. Intrauterine insemination treatment in subfertility: an analysis of factors affecting outcome. Hum Reprod. 1999;14:698-703.

Dinelli L, Courbière B, Achard V, Jouve E, Deveze C, Gnisci A, et al. Prognostis factors of pregnancy after intrauterine insemination with the husband's sperm: conclusions of an analysis of 2,019 cycles. Fertil Steril. 2014;101:994-1000.

Steures P, van der Steeg JW, Mol BW, Eijkemans MJ, van der Veen F, Habbema JD, et al. CECERM (Collaborative Effort in Clinical Evaluation in Reproductive Medicine). Prediction of an ongoing pregnancy after intrauterine insemination. Fertil Steril. 2004;82:45-51.

Berlanda N, Vercellini P, Fedele L. The outcomes of repeat surgery for recurrent symptomatic endometriosis. Current Opinion Obstet Gynecol. 2010;22(4):320-5.

Tomassetti C, Meuleman C, Pexsters A, Mihalyi A, Kyama C, Simsa P, et al. Endometriosis, recurrent miscarriage and implantation failure: is there an immunological link? Reprod BioMed Online. 2006;13(1):58-64.

Al-Fadhli R, Kelly SM, Tulandi T, Tanr SL. Effects of different stages of endometriosis on the outcome of in vitro fertilization. J Obstet Gynaecol Can. 2006;28:888-91.