Impact of Prolonged Versus OCP Plus Long Protocol on IVF-ET Outcomes in Patients With Grade III-IV Endometriosis: A Randomized Clinical Trial
The purpose of the current study was to investigate the impact of a 2-months implementation of GnRH-agonist (prolonged) versus the OCP+long protocol before in-vitro fertilization-embryo transfer (IVF-ET) on IVF outcomes in infertile patients with Grade III-IV endometriosis. A total of 70 infertile patients with endometriosis participated in this randomized clinical trial and randomly received either the prolonged GnRH-agonist protocol (38 patients) as control or the OCP+long protocol (32 patients) as the case group. This was followed by standard controlled ovarian hyperstimulation (COH) in all subjects. The fertilization rate, the implantation rate, and the clinical pregnancy rate were measured and compared between the two groups. A statistically significant trend toward better embryo quality was observed in the control group (P=0.01). In addition, clinical pregnancy rate, implantation rate and fertilization rate did not differ significantly between two groups (P=0.43, P=0.54, P=0.1 respectively). GnRH agonist treatment for 2 months before ART in women with high-grade endometriosis was associated with better embryo quality compared to three weeks of treatment with OCP. OCP before assisted reproductive technology (ART) was as effective as GnRH agonist treatment regarding clinical pregnancy and implantation rates in infertile patients with severe endometriosis.
Ghajarzadeh M, Tanha FD, Akrami M, Mohseni M, Askari F, Farsi L. Do Iranian Women with Endometriosis Suffer from Sexual Dysfunction? Sex Disabil 2014;32:189-95.
Azem F, Lessing JB, Geva E, Shahar A, Lerner-Geva L, Yovel I, et al. Patients with stages III and IV endometriosis have a poorer outcome of in vitro fertilization-embryo transfer than patients with tubal infertility. Fertil Steril 1999;72:1107-9.
Brizek CL, Schlaff S, Pellegrini VA, Frank JB, Worrilow KC. Increased incidence of aberrant morphological phenotypes in human embryogenesis--an association with endometriosis. J Assist Reprod Genet 1995;12:106-12.
Garrido N, Navarro J, Garcia-Velasco J, Remoh J, Pellice A, Simon C. The endometrium versus embryonic quality in endometriosis-related infertility. Hum Reprod Update 2002;8:95-103.
Ballester M, Oppenheimer A, d'Argent EM, Touboul C, Antoine JM, Coutant C, et al. Nomogram to predict pregnancy rate after ICSI-IVF cycle in patients with endometriosis. Hum Reprod 2012;27:451-6.
Kuivasaari P, Hippelainen M, Anttila M, Heinonen S. Effect of endometriosis on IVF/ICSI outcome: stage III/IV endometriosis worsens cumulative pregnancy and live-born rates. Hum Reprod 2005;20:3130-5.
Surrey ES. Endometriosis and assisted reproductive technologies: maximizing outcomes. Semin Reprod Med 2013;31:154-63.
Sallam HN, Garcia‐Velasco JA, Dias S, Arici A, Abou‐Setta AM. Long‐term pituitary down‐regulation before in vitro fertilization (IVF) for women with endometriosis Cochrane Database Syst Rev 2006;1:CD004635.
de Ziegler D, Gayet V, Aubriot FX, Fauque P, Streuli I, Wolf JP, et al. Use of oral contraceptives in women with endometriosis before assisted reproduction treatment improves outcomes. Fertil Steril 2010;94:2796-9.
Surrey ES, Silverberg KM, Surrey MW, Schoolcraft WB. Effect of prolonged gonadotropin-releasing hormone agonist therapy on the outcome of in vitro fertilization-embryo transfer in patients with endometriosis. Fertil Steril 2002;78:699-704.
van der Houwen LE, Mijatovic V, Leemhuis E, Schats R, Heymans MW, Lambalk CB, et al. Efficacy and safety of IVF/ICSI in patients with severe endometriosis after long-term pituitary down-regulation. Reprod Biomed Online 2014;28:39-46.
Mohamed AM, Chouliaras S, Jones CJ, Nardo LG. Live birth rate in fresh and frozen embryo transfer cycles in women with endometriosis. Eur J Obstet Gynecol 2011;156:177-80.
Illera MJ, Juan L, Stewart CL, Cullinan E, Ruman J, Lessey BA. Effect of peritoneal fluid from women with endometriosis on implantation in the mouse model. Fertil Steril 2000;74:41-8.
Taylor HS, Bagot C, Kardana A, Olive D, Arici A. HOX gene expression is altered in the endometrium of women with endometriosis. Hum Reprod 1999;14:1328-31.
Burney RO, Talbi S, Hamilton AE, Vo KC, Nyegaard M, Nezhat CR, et al. Gene expression analysis of endometrium reveals progesterone resistance and
candidate susceptibility genes in women with endometriosis. Endocrinology 2007;148:3814-26.
Berbic M, Schulke L, Markham R, Tokushige N, Russell P, Fraser IS. Macrophage expression in endometrium of women with and without endometriosis. Hum Reprod 2009;24:325-32.
Augoulea A, Mastorakos G, Lambrinoudaki I, Christodoulakos G, Creatsas G. The role of the oxidative-stress in the endometriosis-related infertility. Gynecol Endocrinol 2009;25:75-81.
Falconer H, Sundqvist J, Gemzell-Danielsson K, von Schoultz B, D'Hooghe TM, Fried G. IVF outcome in women with endometriosis in relation to tumour necrosis factor and anti-Mullerian hormone. Reprod Biomed Online 2009;18:582-8.
Tamura H, Takasaki A, Nakamura Y, Numa F, Sugino N. A pilot study to search possible mechanisms of ultralong gonadotropin-releasing hormone agonist therapy in IVF-ET patients with endometriosis. J Ovarian Res 2014;7:100.
Reiter RJ, Tan DX, Fuentes-Broto L. Melatonin: a multitasking molecule. Progress in brain research. 2010;181:127-51.
Iwabe T, Harada T, Sakamoto Y, Iba Y, Horie S, Mitsunari M, et al. Gonadotropin-releasing hormone agonist treatment reduced serum interleukin-6 concentrations in patients with ovarian endometriomas. Fertil Steril 2003;80:300-4
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.