The clinical efficacy of medical treatment and / or laparoscopic surgery for the improvement of pregnancy rate after IVF - ET in the infertile patients with endometriosis

Yoo, Keun Jai; Yang, Kwang Moon; Song, Ji Hong; Lee, Jae Hoon; Kim, Kye Hyun; Song, In Ok; Choi, Bum Chae; Koong, Mi Kyoung; Choi, Kyu Hong; Kang, In Soo

Abstract

OBJECTIVE
The aim of study was to evaluate the efficacy of medical and/or laparoscopic surgical treatment for improvement of reproductive outcome of in vitro fertilization and embryo transfer (IVF-ET) in the patients with endometriosis.
METHODS
296 IVF-ET cycles except 18 cycles of cancelled embryo-transfer (unfertilization; 16 cycles, high risk of ovarian hyperstimulation syndrome; 2 cycles) in 191 infertile women with endometriosis from January 1, 1995 to December 31, 1998 were included in this study. All women's ages were < or = 35 and the factor for infetility was endometriosis only and day 3 follicle stumulating hormone (FSH) level of all the cycles was < or = 10 mIU/ml in this study. All the baseline study about infertility was done before initiating treatment of infertility. The stage of endometriosis was recorded during diagnostic laparoscopy by WHO critera. Medical treatment (GnRH agonist or danazole) or laparoscopic surgery was done independently or combinedly by the physician's decision according to the disease entity and symptoms. Short or long protocols were used for controlled ovarian hyperstimulation and 3 day embryos were transferred (maximally 4 embryos) by standard procedures in our institute. We classified the cases as 4 groups : group 1 (without pre-treatment, 80 cycles), goup 2 (laparoscopic surgery only, 37 cycles), group 3 (medication only, 140 cycles), group IV (combined pre-treatment, 39 cycles).
RESULTS
The mean age (years old, mean +/- SEM) was 31.5 +/- 0.3 (group 1), 31.6 +/- 0.5 (group 2), 31.5 +/- 0.2 (group 3), 31.7 +/- 0.4 (group 4) respectively. The duration of infertility (months) was 57.7 +/- 3.3, 64.5 +/- 4.8, 59.1 +/- 1.9, 52.0 +/- 3.7 respectively among groups. The viable pregnancy rate (over 28 gestational weeks, VPR) was 12.5 % (10/80) in goup 1, 13.5 % (5/37) in goup 2, 14.3 % (20/140) in group 3, 30.8 % (12/39) in group 4 and there was statistically significant difference between group 1 and group 4 (P=0.03, Chi square test). The total used gonadotropins (ampules) for controlled ovarian hyperstimulation were 28.2 +/- 0.6.