Comparison of Ovulation Induction Protocols After Endometrioma Resection

Baştu, Ercan; Yaşa, Cenk; Dural, Özlem; Mutlu, Mehmet Fırat; Çelik, Cem; Uğurlucan, Funda Güngör; Buyru, Faruk

doi:10.4293/jsls.2014.00128

Cited by 15 publications

(33 citation statements)

References 41 publications

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“…Many researchers have attempted to overcome this obstacle using either oral contraceptive pills [18] or levonorgestrel-releasing IUDs [19], but these methods cannot directly facilitate IVF. Two retrospective studies reported that GnRH antagonist (GnRH-ant) protocols can achieve comparable results to those of long-term GnRH-a protocols in EMs patients [20,21]. However, a Cochrane meta-analysis by Al-Inany and Aboulghar suggested that GnRH-ant protocols negatively affected pregnancy rates [22].…”

Section: Discussionmentioning

confidence: 99%

Efficacy and Safety of In Vitro Fertilization (IVF)/Intracytoplasmic Sperm Injection (ICSI) Among Patients with Endometriosis After a Shortened Protocol of Long-Term Pituitary Downregulation

Kong

Guo

et al. 2019

Med Sci Monit

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Background Patients with endometriosis (EMs) are routinely advised to take GnRH-a for 3–6 months to improve the internal reproductive environment, but this may not be necessary. Material/Methods This retrospective study examined the effects of in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) with shortened (n=311) or conventional (n=213) long-term pituitary downregulation in EMs patients between January 2013 and July 2017. Results The 2 groups showed no significant differences in gonadotropin (Gn) dose, number of oocytes retrieved, or miscarriage rate. Follicle-stimulating hormone (FSH), luteinizing hormone (LH), and estradiol (E2) levels on the initiation day and the LH level on human chorionic gonadotropin (hCG) day (1.22±1.39 vs. 0.74±0.55 P=0.0026) were higher in the study group than in the control group. The cumulative live birth rates in the second cycle were 69.13% in the study group (95% confidence interval (CI), 64–74.27%) vs. 68.54% in the control group (95% CI, 62.31–74.78%, P=0.88, respectively). Conclusions This study showed that the shortened regimen and the ultralong regimen did not produce different pregnancy outcomes after ART, and the single-application, long-term GnRH-a protocol may serve as a cost-effective and safe treatment protocol for EMs patients.

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Section: Discussionmentioning

confidence: 99%

Efficacy and Safety of In Vitro Fertilization (IVF)/Intracytoplasmic Sperm Injection (ICSI) Among Patients with Endometriosis After a Shortened Protocol of Long-Term Pituitary Downregulation

Kong

Guo

et al. 2019

Med Sci Monit

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“…The two protocols, GnRH-a and GnRH-ant, were used for endometriosis patients undergoing COS. Pabuccu et al, in their prospective randomized trial study compared the long GnRH-a protocol to the GnRH-ant in endometriosis (grade I and II) and endometrioma in ICSI cycles, and reported that both protocols are equally effective in such patients (41). In a recent study, Bastu et al showed that the outcomes of IVF in both protocols were similar in endometriosis patients (42).…”

Section: Discussionmentioning

confidence: 99%

Controlled Ovarian Stimulation in Endometriosis Patients Can Be Individualized by Anti-Mullerian Hormone Levels

et al. 2017

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Context. Anti-Mullerian hormone (AMH) assay is becoming the best indicator of successful IVF treatment response to fertility drugs and could be a useful marker of embryo implantation potential. Various protocols are being used for controlled ovarian stimulation (COS), but there is an uncertainty regarding the implementation of the best protocol for endometriosis patients and also little evidence is available concerning the clinical value of AMH levels in endometriosis.Objective. This study aimed to evaluate the prognostic value of serum AMH levels for pregnancy in COS using GnRH-agonist(GnRH-a) and GnRHantagonist(GnRH-ant) protocols in endometriosis patients.Design. This is a cross-sectional study between March 2012 and November 2015.Subjects and Methods. Data were collected from 249 COS cycles of endometriosis patients, including 129 cycles with GnRH-a and 120 cycles with GnRH-ant. Patients in each group were classified into three subgroups based on their serum AMH levels. The outcomes of ICSI program were evaluated.Results. The ROC curve analysis showed that embryo and oocyte counts and AMH were equally predictive for pregnancy, as demonstrated by a similar area under the curve (AUC) of 0.69, 0.66 and 0.64, respectively. The sensitivity and specificity for prediction of positive pregnancy were 70.91% and 67.01% for embryo counts, 70.91% and 67.53% for oocyte counts at the cutoff values of 5 and 7, respectively, and 83.64% and 52.58% for AMH levels at the cutoff values of 1.3ng/mL.Conclusions. This study demonstrates that AMH as a single test has substantial accuracy in the prediction of pregnancy using the GnRH antagonist protocol for patients with endometriosis. In other words, AMH assay prior to ovarian stimulation initiation guides the clinicians to choose the antagonist stimulation protocol for the patients with two extreme AMH levels. AMH levels can be used to individualize control ovarian stimulation in endometriosis patients.

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“…this combination of strategy of coh is proven by many studies to improve clinical pregnancy rate, ongoing pregnancy rate, and implantation rate. [17][18][19][20] the duration of downregulation also affects the pregnancy outcome. early studies also revealed that 3-6 months duration of downregulation might improve the overall success rate of ivF.…”

Section: Discussionmentioning

confidence: 99%

“…however, the efficacy needs to be balanced with the cost and side effects of hypo-estrogenism to the women. [17][18][19] the integrated approach of surgery-ivF-et yield a good pregnancy rate of 56% compared to 37% if surgery alone. 21,22 our study also demonstrated that the combination of surgery with integrated stimulation (Gnrh analogue + coh)-icSi-et also enhances the pregnancy outcome in endometriosis.…”

Section: Discussionmentioning

confidence: 99%

“…Gnrh agonist protocol leads to a higher number of embryos, that can be cryopreserved. 17 this can lead to the possibility of additional embryo transfers without oocytes retrieved, number of Mii oocytes, number of grade 1 embryo and the number of frozen embryo between stage iii and iv endometriosis group. although there was no statistical difference, the cancellation of the cycle is higher in stage iii and iv endometriosis compared to stage ii (table ii).…”

Section: Assessment Of Outcomementioning

confidence: 99%

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Endometriosis related infertility. Analysis of IVF/ICSI outcome: should GNRH analogue be integrated with control ovarian stimulation?

Jamaludin¹,

Zain²,

Keat³

et al. 2020

Gazz Med Ital - Arch Sci Med

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BacKGroUnd: the aim of this study was to evaluate the ivF/icSi outcome in endometriosis patient who received Gnrh analog as downregulation prior control ovarian stimulation (coh). MethodS: a retrospective study involving 86 women with endometriosis who had undergone ivF at our center between January 2015 till december 2017. the clinical pregnancy rate analyzed as the primary endpoint. other outcomes measured include the total dose gonadotropin, the duration of stimulation, the number of oocytes retrieved, the number of Mii oocytes, the number of grade 1 embryo, number of embryo transfer and frozen, fertilization and cancellation cycle rate. reSUltS: three groups were analyzed including stage ii (n.=26), stage iii (n.=27) and stage iv (n.=31). the clinical pregnancy rate higher in stage ii compares to stage iii and iv (69.2% vs. 37% vs. 38.7%). Surprisingly, they also had more follicles, oocytes retrieved and MII oocytes. The number of grade 1 embryo also significant seen in stage II compared to stage iii and iv with p-value 0.006 (3.15±2.3 vs. 2±1.49 vs. 1.63±1.40). Women with stage iii and iv endometriosis required a higher dose of endometriosis significantly (2781.94±835.57 and 2708.73±962.07) compared to stage ii (2052.40±620.79). the duration of stimulation is almost similar in all stages of endometriosis. there was a similar result seen in the number of embryos transferred. A more frozen embryo is seen in stage II endometriosis significantly. conclUSionS: Gnrh analogue integrated with coh protocol is recommended as a proper stimulation protocol for endometriosis especially in stage ii endometriosis.

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Comparison of Ovulation Induction Protocols After Endometrioma Resection

Cited by 15 publications

References 41 publications

Efficacy and Safety of In Vitro Fertilization (IVF)/Intracytoplasmic Sperm Injection (ICSI) Among Patients with Endometriosis After a Shortened Protocol of Long-Term Pituitary Downregulation

Efficacy and Safety of In Vitro Fertilization (IVF)/Intracytoplasmic Sperm Injection (ICSI) Among Patients with Endometriosis After a Shortened Protocol of Long-Term Pituitary Downregulation

Controlled Ovarian Stimulation in Endometriosis Patients Can Be Individualized by Anti-Mullerian Hormone Levels

Endometriosis related infertility. Analysis of IVF/ICSI outcome: should GNRH analogue be integrated with control ovarian stimulation?

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