Clinical and Experimental Reproductive Medicine

The Korean Society for Reproductive Medicine (대한생식의학회)
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Comparison of IVF-ET Outcome after Various Therapeutic Approaches for Ovarian Endometriomas

난소의 자궁내막종에 대한 다양한 치료적 적용에 따른 체외수정 및 배아이식술 결과의 비교 연구

  • Lee, Bang-Hyun (Department of Obstetrics and Gynecology, Major Women's Care Center) ;
  • Kwon, Hyuck-Chan (Department of Obstetrics and Gynecology, Major Women's Care Center) ;
  • Lee, Jae-Hyun (Division of Reproductive Endocrinology & Infertility, Major Women's Care Center) ;
  • Kim, Bo-Hyun (Division of Reproductive Endocrinology & Infertility, Major Women's Care Center) ;
  • Lee, Sang-Hee (Department of Obstetrics and Gynecology, Major Women's Care Center) ;
  • Park, Min-Hye (Department of Obstetrics and Gynecology, Major Women's Care Center) ;
  • Lee, Byung-Kwan (Department of Obstetrics and Gynecology, Major Women's Care Center) ;
  • Lim, Jung-Ae (Department of Obstetrics and Gynecology, Major Women's Care Center)
  • Published : 2004.06.30
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Abstract

Objective: To compare COH characteristics and IVF outcomes among IVF-ET patients who were treated with various therapeutic modalities for ovarian endometriomas and to propose effective pre-cyclic therapeutic modalities to improve IVF-ET outcomes in the patients with ovarian endometriomas. Methods: All cases that had undergone IVF-ET after laparoscopy between January 1997 to August 2003 were reviewed. Forty-eight patients with tubal factor were assigned to Group I. Twenty seven, 22 and 38 patients diagnosed as severe pelvic adhesion with ovarian endometriomas by laparoscopy received only medical therapy (Group II), cyst aspiration (Group III), and sclerotherapy (Group IV), respectively. Laparoscopic cystectomy was performed in 20 patients (Group V). Resistance index was measured on day administering hCG. Results: As compared with Group I, in Group II resistance index increased (p<0.05) but number of oocytes, good-quality oocyte ratio (mature and intermediate oocytes/total retrieval oocytes), fertilization rate, and embryo development rate decreased (p<0.05). In Group III fertilization rate and embryo development rate decreased (p<0.05). There was no difference between Group IV and Group I in all parameters except basal FSH which increased (p<0.05). In Group V basal FSH, and resistance increased (p<0.05) and number of oocytes and good-quality oocytes ratio decreased (p<0.05). Conclusion: Sclerotherapy is an effective therapeutic option which can be done prior to IVF-ET cycles in the patients with ovarian endometriomas. Further studies on a large scale are necessary to confirm these data.

Keywords

References

  1. Witz CA, Burns WN. Endometriosis and infertility: is there a cause and effect relationship? Gynecol Obstet Invest 2002; 53 Suppl 1: 2-11
  2. Olive DL, Haney AF. Endometriosis--associated infertility: a critical review of therapeutic approaches.Obstet Gynecol Surv 1986; 41(9): 538-55
  3. Yovich JL, Matson PL, Richardson PA, Hilliard C: Hormonal profiles and embryo quality in women with severe endometriosis treated by in vitro fertilization and embryo transfer. Fertil Steril 1988; 50: 308-13 https://doi.org/10.1016/S0015-0282(16)60078-X
  4. Dlugi AM, Loy RA, Dieterie S, Bayer SR, Seibel MM: The effect of endometriomas on in vitro fertilization outcome. J In Vitro Fert Embryo Tranfer 1989; 6: 338-41 https://doi.org/10.1007/BF01138773
  5. Ho HY, Lee RK, Hwu YM, Lin MH, Su JT, Tsai YC. Poor response of ovaries with endometrioma previously treated with cystectomy to controlled ovarian hyperstimulation. J Assist Reprod Genet 2002; 19(11): 507-11 https://doi.org/10.1023/A:1020970417778
  6. Chang CC, Lee HF, Tsai HD, Lo HY. Sclerotherapy--an adjuvant therapy to endometriosis. Int J Gynaecol Obstet 1997; 59(1): 31-4 https://doi.org/10.1016/S0020-7292(97)00122-7
  7. Yanushpolsky EH, Best CL, Jackson KV, Clarke RN, Barbieri RL, Hornstein MD. Effects of endometriomas on ooccyte quality, embryo quality, and pregnancy rates in in vitro fertilization cycles: a prospective, case-controlled study. J Assist Reprod Genet 1998; 15(4): 193-7 https://doi.org/10.1023/A:1023048318719
  8. Al-Azemi M, Bernal AL, Steele J, Gramsbergen I, Barlow D, Kennedy S. Ovarian response to repeated controlled stimulation in in-vitro fertilization cycles in patients with ovarian endometriosis. Hum Reprod 2000; 15(1): 72-5 https://doi.org/10.1093/humrep/15.1.72
  9. Donnez J, Squifflet J, Pirard C, Jadoul P, Wyns C, Smets M. The efficacy of medical and surgical treatment of endometriosis-associated infertility and pelvic pain. Gynecol Obstet Invest 2002; 54 Suppl 1: 2-7; discussion 7-10
  10. Donnez J, Chantraine F, Nisolle M. The efficacy of medical and surgical treatment of endometriosis-associated infertility: arguments in favour of a medico-surgical aproach. Hum Reprod Update 2002; 8(1): 89-94 https://doi.org/10.1093/humupd/8.1.89
  11. Vercellini P, Vendola N, Bocciolone L, Colombo A, Rognoni MT, Bolis G. Laparoscopic aspiration of ovarian endometriomas. Effect with postoperative gonadotropin releasing hormone agonist treatment. J Reprod Med 1992; 37(7): 577-80
  12. Giorlandino C, Taramanni C, Muzii L, Santillo E, Nanni C, Vizzone A. Ultrasound-guided aspiration of ovarian endometriotic cysts. Int J Gynaecol Obstet 1993; 43(1): 41-4 https://doi.org/10.1016/0020-7292(93)90272-X
  13. Saleh A, Tulandi T. Reoperation after laparoscopic treatment of ovarian endometriomas by excision and by fenestration. Fertil Steril 1999; 72(2): 322-4 https://doi.org/10.1016/S0015-0282(99)00243-5
  14. Chang CC, Lee HF, Tsai HD, Lo HY. Sclerotherapy--an adjuvant therapy to endometriosis. Int J Gyna-ecol Obstet 1997; 59(1): 31-4 https://doi.org/10.1016/S0020-7292(97)00122-7
  15. Noma J, Yoshida N. Efficacy of ethanol sclerotherapy for ovarian endometriomas Int J Gynaecol Obstet 2001; 72(1): 35-9
  16. Koike T, Minakami H, Motoyama M, Ogawa S, Fujiwara H, Sato I. Reproductive performance after ultrasound-guided transvaginal ethanol sclerotherapy for ovarian endometriotic cysts. Eur J Obstet Gynecol Reprod Biol 2002; 105(1): 39 https://doi.org/10.1016/S0301-2115(02)00144-6
  17. Messalli EM, Cobellis G, Pecori E, Pierno G, Scaffa C, Stradella L, et al. Alcohol sclerosis of endometriomas after ultrasound-guided aspiration. Minerva Ginecol 2003; 55(4): 359-62
  18. Kafali H, Yurtseven S, Atmaca F, Ozardali I. Management of non-neoplastic ovarian cysts with sclerotherapy. Int J Gynaecol Obstet 2003; 81(1): 41-5 https://doi.org/10.1016/S0020-7292(02)00401-0
  19. Mittal S, Kumar S, Kumar A, Verma A. Ultrasound guided aspiration of endometrioma --a new therapeutic modality to improve reproductive outcome. Int J Gynaecol Obstet 1999; 65(1): 17-23 https://doi.org/10.1016/S0020-7292(98)00218-5
  20. 이희춘, 유정현, 황경주, 권혁찬, 장기홍, 유희석 등. 재발된 양성 자궁부속기 낭종의 치료에 있어서 경화치료술의 효용성. 대한산부회지 1998; 41(4): 1055-60
  21. Fayez JA, Vogel MF. Comparison of different treatment methods of endometriomas by laparoscopy. Obstet Gynecol 1991; 78(4): 660-5
  22. Donnez J, Nisolle M, Gillet N, Smets M, Bassil S, Casanas-Roux F. Large ovarian endometriomas Hum Reprod 1996; 11(3): 641-6
  23. Beretta P, Franchi M, Ghezzi F, Busacca M, Zupi E, Bolis P. Randomized clinical trial of two laparoscopic treatments of endometriomas: cystectomy versus drainage and coagulation. Fertil Steril 1998; 70(6):1176-80 https://doi.org/10.1016/S0015-0282(98)00385-9
  24. Hemmings R, Bissonnette F, Bouzayen R. Results of laparoscopic treatments of ovarian endometriomas: laparoscopic ovarian fenestration and coagulation. Fertil Steril 1998; 70(3): 527-9 https://doi.org/10.1016/S0015-0282(98)00219-2
  25. Milingos S, Kallipolitis G, Loutradis D, Liapi A, Drakakis P, Antsaklis A, et al. Factors affecting postoperative pregnancy rate after endoscopic management of large endometriomata. Int J Gynaecol Obstet 1998; 63(2): 129-37 https://doi.org/10.1016/S0020-7292(98)00148-9
  26. Yoshida S, Harada T, Iwabe T, Terakawa N. Laparoscopic surgery for the management of ovarian endometrioma. Gynecol Obstet Invest 2002; 54 Suppl 1: 24-7; discussion 27-9
  27. Marconi G, Vilela M, Quintana R, Sueldo C. Laparoscopic ovarian cystectomy of endometriomas does not affect the ovarian response to gonadotropin stimulation. Fertil Steril 2002; 78(4): 876-8 https://doi.org/10.1016/S0015-0282(02)03326-5
  28. Canis M, Pouly JL, Tamburro S, Mage G, Wattiez A, Bruhat MA. Ovarian response during IVF-embryo transfer cycles after laparoscopic ovarian cystectomy for endometriotic cysts of >3 cm in diameter. Hum Reprod 2001; 16(12): 2583-6 https://doi.org/10.1093/humrep/16.12.2583