ENDOMETRIOSIS-ASSOCIATED SURGERY: IMPACT OF LAPAROSCOPIC OPERATIONS ON IN VITRO FERTILIZATION OUTCOMES IN WOMEN WITH OVARIAN ENDOMETRIOSIS
DOI:
https://doi.org/10.11603/2414-4533.2024.2.14845Keywords:
infertility, assisted reproductive technologies, in vitro fertilization, endometriosis, laparoscopy, sclerotherapy, pregnancyAbstract
The aim of the work: to evaluate the impact of endometriosis-associated surgical interventions on in vitro fertilization outcomes in women with ovarian endometriosis.
Materials and Methods. A retrospective analysis of 112 outpatient medical records of infertile women was conducted. Three study groups were formed: Group I – 42 women with endometriosis-associated infertility who had a history of surgical treatment for ovarian endometriomas and did not have active endometriosis at the beginning of the stimulation cycle; Group II – 40 patients with unilateral or bilateral active endometriomas who did not undergo surgical treatment; Group III (control) – 30 women with infertility solely due to tubal factors.
Results and Discussion. Significant differences between the groups were identified based on surgical interventions and manipulations performed according to medical history. Both laparotomy and laparoscopy were frequent surgical interventions in the first group and the control group. Some women reported undergoing diagnostic laparoscopy to establish a probable cause of infertility or to verify the diagnosis of external endometriosis. According to embryological protocols, a lower number of mature follicles >18 mm in diameter was observed in the first group, associated with the thermal impact of laparoscopic interventions on ovarian tissue, and in the second group of women with active endometriomas during stimulation, explained by poorer access to some follicles due to cyst presence. The smallest number of retrieved oocytes (5.86±0.35) and the highest proportion of immature oocytes were recorded in the first group, which did not correlate with the magnitude of stimulation and may be explained by the absence of necessary follicle receptor sensitivity to gonadotropins due to previous laparoscopic interventions. The smallest number of blastocysts was obtained in the first group (1.09±0.16), which is an expected result considering the smallest number of retrieved oocytes (5.86±0.35), of which mature and correctly fertilized oocytes (3.02±0.32 and 1.68±0.17, respectively) were also the lowest compared to women in the second investigated and control groups.
Conclusions. Previous endometriosis-associated surgical interventions in medical history are a potential factor for unsuccessful IVF cycles due to their negative impact on oocyte retrieval, their morphological quality, fertilization rates, and blastulation.
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