Comparative effectiveness of infertility treatment using assisted reproductive technologies in patients with various forms of endometriosis and its combination with polycystic ovary syndrome

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Abstract

AIM: The purpose of this study is to investigate the influence of various forms of endometriosis and its combination with PCOS on the outcome of assisted reproductive technology programs (ART) with relation to ovarian stimulation.

MATERIALS AND METHODS: During a retrospective examination, we analyzed the results of 241 ART cycles. All patients were divided into three groups: group A: endometriosis (85 ART cycles); group B: combination with PCOS (53 ART cycles), comparison group with tuboperitoneal infertility (103 ART cycles). Group A was subdivided into subgroup A1 with stage I / II endometriosis (50 cases, 58.82%) and subgroup A2 with stage III / IV endometriosis (35 cases, 41.18%). At the first stage of the study, we evaluated the anamnesis and the results of clinical and laboratory tests. During the second stage, we performed laparo- and hysteroscopy surgeries and determined the stage of endometriosis as well as the presence of concomitant pathologies. At the third stage, we performed infertility treatment using ART.

RESULTS: The highest FSH dose was employed in group A2 with the ovarian stimulation performed with GnRH-a: 2230.80 ± 614.09 IU. The minimal dose was used for group A1 (stimulation with antGnRH): 1171.43 ± 547.42 IU. The highest pregnancy rate per embryo transfer (PR) was detected in group A1 with the use of GnRH-a (50%,) higher than in the comparison group (42.72%). The minimal PR (14.29%) was found in group A2 (stimulation with antGnRH). Live Birth Rate (LBR) was higher in A1 patients stimulated with GnRH-a (40.48%), while with the use of antGnRH, all pregnancies terminated in both groups A1 and A2.

CONCLUSIONS: Our study confirmed that common forms of endometriosis are associated with a decrease in the effectiveness of infertility treatment using ART, but minimal forms of endometriosis do not affect the outcomes of ART cycles. The study revealed a negative impact of an ovarian stimulation protocol with the use of antGnRH on IVF outcomes including patients with the combination of endometriosis and PCOS. However, the small number of cases studied dictates further research to be conducted in this field.

About the authors

Alexander A. Makolkin

Delta Fertility Clinic Ltd.

Email: mail@makolkin.com
ORCID iD: 0000-0001-8858-7333
https://df.clinic/

MD, obstetrician-gynecologist, reproductologist

Russian Federation, 10, 13th line of Vasilievsky Island, Saint Petersburg, 199034

Alla S. Kalugina

Academician I.P. Pavlov First Saint Petersburg State Medical University

Author for correspondence.
Email: alla19021962@gmail.com
https://scanfert.clinic

MD, Dr. Sci. (Med.), Professor

Russian Federation, Saint Petersburg

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2. Figure. Groups of female patients. ART — assisted reproductive technologies; E — endometriosis; PCOS — polycystic ovary syndrome; TPI — tuboperitoneal infertility. A, B, A1, and A2 — study groups and subgroups

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