Endometriosis and IVF
Issue 19: 11 Sep 2006
Source: Reviews in Gynaecological and Perinatal Practice 2006; 6: 153-60
A new review paper addresses how to optimize IVF outcomes in women with endometriosis.
In the journal Reviews in Gynaecological and Perinatal Practice, specialists from the Liverpool Women’s Hospital, UK, note that published data on the effect of endometriosis on IVF are conflicting.
Both the European Society of Human Reproduction and Embryology (ESHRE) and the UK’s Royal College of Obstetricians and Gynaecologists (RCOG) have issued statements, based on meta-analyses, in which endometriosis is considered to worsen the prognosis of IVF.
One of most recent meta-analyses concluded that endometriosis stage influences different IVF outcomes, impairing the number of oocytes retrieved, implantation, pregnancy, and fertility rates. However, the analysis was based on retrospective studies, and could not evaluate the effect of endometriosis on the live birth rate after IVF.
In their paper, the specialists discuss in detail what is known about the effects on IVF outcomes of: medical management of endometriosis prior to IVF; surgical management of endometriosis; and surgical management of endometriomas (including transvaginal aspiration).
Based on their findings, they recommend a series of “practice points”, which include:
“Early referral to centres of excellence and early treatment of infertility should always be considered.”
“In asymptomatic patients waiting for IVF, there seems to be no justification for routine surgery with views to improve success rates.”
“Surgery is indicated for symptomatic endometriomas, and those patients with large endometriomas (>5 cm) should be considered for surgical removal of endometriomata based on clinical grounds and according to individual hospital protocols.”
“Asymptomatic endometriomas diagnosed during an IVF treatment cycle must be kept under surveillance, but their removal does not seem to be indicated in view to improve fertility.”
“Repeated surgery for endometriosis is discouraged in asymptomatic patients prior to IVF, even in the presence of endometriomas.”
“Due to the risks inherent to the procedure, it seems to be prudent not to drain asymptomatic ovarian endometriomas identified during an IVF treatment cycle, including the time of oocyte retrieval.”
The specialists also note that there is some evidence that GnRH analogues given for 3-6 months before IVF treatment cycles may improve pregnancy rates in patients with moderate to severe endometriosis.
http://www.orgyn.com/en/webzine/2006...89724190162037
Endometriosis and IVF 
