RESULTS OF TREATMENT OF OVARIAN ENDOMETRIOS IN THE PROGRAMS OF ASSISTED REPRODUCTIVE TECHNOLOGIES
DOI:
https://doi.org/10.11603/1681-2786.2022.4.13686Keywords:
endometriosis-associated infertility, endometrioma, sclerotherapy, assisted reproductive technologies, ovulation stimulation, ovulatory reserve, chronic pelvic pain, folliculogenesis, IVF programs, protocol pretreatment, testosterone, DHEA, alpha-lipoic acid, ovaryAbstract
Purpose: to study the effectiveness of controlled ovarian stimulation (COS) protocols using protocol pretreatment and sclerotherapy in patients with endometriosis-associated infertility.
Materials and Methods. 126 women with endometriosis-associated and tubal infertility were examined, who were a control group. The patients were divided into 3 clinical groups. Group 1 – 51 patients with infertility on the background of endometriosis, who 2 months before the COS protocol with GnRH antagonists underwent a course of protocol pretreatment and sclerotherapy of the endometrioid cyst. Group 2 consisted of 45 patients with infertility on the background of endometriosis, who had a history of surgical treatment. Group 3 includes 30 women with tubal factor infertility. Depending on the tactics of treatment and the use of protocol pretreatment, the characteristics of folliculogenesis of both research groups and the control group were developed.
Results. Mean total dose of rFSH, duration of GnRH antagonist administration, duration of ovulation stimulation, number of follicles >18 mm in diameter obtained, progesterone level on the day of ovulation trigger administration, serum and follicular testosterone levels in a group of women with endometriosis-associated infertility who were offered sclerotherapy together with protocol pretreatment is not statistically significantly different from the results of the control group of women with tubal factor infertility, however, a statistical difference was found between the groups of women with endometriosis-associated infertility who underwent conservative and operative treatment of endometrioma, which subsequently affected the results of IVF.
Conclusions. Women with endometriosis-associated infertility are a patient category with a poorer response to ovulation stimulation in IVF programs. Surgical treatment of endometrioma can further worsen the ovarian response by inadvertently removing its healthy tissue. Therefore, an adequate alternative to surgery is sclerotherapy of the cyst, which allows preserving the follicular apparatus of the ovary and applying a strategy of mild stimulation in women with a worse ovarian reserve undergoing IVF.
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