CLINICAL CHARACTERISTICS OF PATIENTS WITH ENDOMETRIOSIS-ASSOCIATED INFERTILITY WHO UNDERWENT CONTROLLED OVARIAN STIMULATION ACCORDING TO A SHORT PROTOCOL
DOI:
https://doi.org/10.11603/24116-4944.2024.1.14753Keywords:
infertility, assisted reproductive technologies, in vitro fertilization, controlled ovarian stimulation, endometriosis, anti-mullerian hormone, pregnancy, miscarriageAbstract
The aim of the study – to evaluate the clinical picture and the impact on the effectiveness of treatment for endometriosis-associated infertility in women undergoing controlled ovarian stimulation according to a short protocol with GnRH antagonists in in vitro fertilization programs.
Materials and Methods. A retrospective analysis of 112 outpatient records was performed. Patients were divided into 3 groups: the first group included 42 women with endometriosis-associated infertility with a history of surgical treatment of ovarian endometriomas and no active endometrioma at the beginning of the stimulation cycle; the second group included 40 patients with unilateral or bilateral active endometriomas who had not undergone surgical treatment; 30 women in the control group had infertility associated exclusively with the tubal factor.
Results and Discussion. The duration of infertility in all groups of women ranged from 3 to 10 years. The lowest mean levels of AMH were recorded in the group of patients with a history of pelvic surgery for ovarian endometriosis and amounted to (0.98 ± 0.11) ng/ml. The duration of stimulation ranged from 9 to 12 days and averaged (11.46 ± 0.25) days in the first group, (11.20 ± 0.22) days in the second group, and (10.45 ± 0.21) days in the control group. In the groups of women with ovarian endometriosis, there was a tendency for higher starting and total doses of gonadotropins per cycle of COS, as well as a longer duration of stimulation and the number of days of ant-GnRH administration. The lowest number of clinical pregnancies (27.50%) and deliveries (15.00%) was recorded in the group of women with active ovarian endometriosis at the time of stimulation. In women with a history of endometriosis-associated surgical interventions, the IVF cycle success rates were slightly better, but also significantly lower than in the control group.
Conclusions. Women with a history of surgery before IVF require more days of stimulation and a higher dose of gonadotropins, and have significantly lower egg and embryo retrieval rates, which potentially affects the overall effectiveness of IVF programs, reducing the incidence of pregnancy and childbirth.
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