The Clinical Impact of Endometriosis on the Outcome of IVF-ET in Infetile Patients

Yoo, K J; Song, J H; Song, I O; Choi, B C; Jun, J H; Son, I P; Koong, M K; Kim, J W; Kang, I S

Abstract

OBJECTIVE
The aim of this study was to evaluate the clinical impact of endometriosis on the outcome of controlled ovarian hyperstimulation [COH] in IVF-ET cycle.
METHODS
Ninety-four IVF-ET cycles [71 by short protocol in 42 women, 23 by long protocol in 19 women] in patients with endometriosis only and 254 cycles [all by short protocol in 172 women] in infertile patients with tubal factor only were included in this study. The patients with endometriosis were divided into two groups according to the disease stage: group I [ endometriosis stage I, II], group II [endometriosis stage III, IV].
RESULTS
The mean [31.7+/-0.3; SEM] age of the patients with endometriosis was not significantly different from that [31.3+/-0.2] of the patients with tubal factor only. More gonadotropin ampules were used in the patients with endometriosis than in the patient with tubal factor only [ 27.7+/-1.2 vs. 24.0+/-0.6; p=0.004, Student`s t-test]. The mean number of cleaved embryos was significantly less [p=0.0014, t-test] in the patients with endometriosis than that of tubal factor group [ 7.0+/-0.5 vs. 9.0+/-0.4]. The clinical pregnancy rate per transfer in the patients with endometriosis were 21.4 % [15/70] in short protocol, 13.0 % [3/23] in long protocol, but it did not reach statistically significant level [p=0.68, Chi-square test]. But significantly less gonadotropin ampules were used in short protocol than in long protocol [27.7+/-1.2 vs.36.1+/-2.2; p=0.001]. The clinical pregnancy rate per transfer were 15.8 % [9/57] in group I, 22.2 % [8/36] in group II, respectively and there was no statistical significance [p=0.58, Chi-square test]. The clinical pregnancy rates per embryo transfer of the patients with endometriosis was 21.1 % [4/19] in the patients with no treatment before IVF-ET, 0.0 % [0/9] in the patients undergone laparoscopic surgery, 14.6 % [7/45] in the patients of having medication and 28.6 % [6/21] in the patients of having combined therapy [laparoscopic surgery plus medication] respectively, even though the clinical pregnancy rate was higher in the patients undergone combined therapy, there was no statistical significance [p=0.41, Chi-square test] among the different treatment modalities.
CONCLUSION
We conclude that endometriosis may affect COH adversely, in terms of number of retrieved good quality oocytes and cleaved embryos and short prtotol could be more useful clinically. Even though there was no significant difference in the clinical pregnancy rate and some limitation with relatively small sample size, combined therapy before IVF-ET would be more helpful for the improvement of the reproductive outcome in the patient with endometriosis but further study would be needed.