Is the endometriosis recurrence rate increased after ovarian hyperstimulation?

Patients affected with severe endometriosis are at significant risk for ovarian tissue damage, which may lead to infertility, reduced response to ovarian stimulation, and occasionally, premature ovarian failure. The risk for a compromised ovarian reserve in young patients is especially high following repeated surgical intervention and in the presence of bilateral endometriomas. In many cases, enhanced loss of ovarian reserve may also result from the damaging effect of the pathologic process on follicle reservoir even without surgical interventions. Women diagnosed with severe endometriosis and those designated for extensive ovarian surgical intervention are frequently not planning to conceive. In light of recent advances in fertility preservation techniques (FPT), such as oocytes and ovarian tissue freezing, as well as their increasing success rates, we critically evaluate the options for FPT in patients suffering from endometriosis. Personalized counseling should be offered to all patients with endometriosis taking into account age, extent of ovarian involvement, current ovarian reserve, previous and impending surgeries for endometriosis, along with current success rates and possible risks associated with FPT.

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“…Number of COH and IVF cycles has not been associated with an increased risk of disease recurrence [46,47].…”

Section: Embryo/egg Freezingmentioning

confidence: 93%

The role of fertility preservation in patients with endometriosis

Carrillo

Seidman

Cittadini

et al. 2016

J Assist Reprod Genet

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“…The aim of controlled ovarian hyperstimulation is to reduce the cycle cancellation rate, increment the number of oocytes and top-quality embryos and ensure better results in terms of pregnancy rates [2][3][4][5]. However, in different clinical situations such as reduced ovarian reserve, previous oncologic or estrogen-dependent disease the natural cycle continue to be considered the method of choice for IVF treatment [6][7][8][9][10][11][12][13][14][15][16].…”

Section: Introductionmentioning

confidence: 99%

Accumulation of oocytes from a few modified natural cycles to improve IVF results: a pilot study

Greco

Litwicka

Arrivi

et al. 2013

J Assist Reprod Genet

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Purpose To evaluate the role of co-transfer of embryos derived from vitrified oocytes accumulated during the previous modified natural cycles and an embryo developed from the last one as an alternative to repetitive single embryo transfer in a fresh modified natural cycle. Methods Thirty-six patients underwent ICSI procedure with three frozen natural oocytes supplemented by a fresh one obtained from the fourth modified natural cycle. Thirty-one controls received at least three consecutive single embryo transfer in a fresh modified natural cycle. Results In the study group the oocyte retrieval, survival and total fertilization rate were 73.0 %, 78.1 %, and 64.5 %, respectively. Fifty-two embryos were transferred in 29 transfers. In the control group the oocyte retrieval and fertilization rate was 77.4 % and 83.7 %, respectively. Fifty single embryo transfers were performed. Of a total 14 pregnancies obtained in the study group 10 were defined as clinical and 4 as abortions. In the control group a total of 8 single clinical pregnancies and 2 miscarriages were encountered. The overall (20.0 % vs 48.2 %) and the clinical (16.0 % vs 34.4 %) pregnancy rate were significantly higher in the study group having cumulative embryo transfer following the oocyte accumulation. Conclusions These data demonstrate that the co-transfer of embryos derived from vitrified oocytes accumulated during the previous modified natural cycles and an embryo developed from the last fresh modified natural cycle assure an excellent clinical outcome with the overall and clinical pregnancy rate significantly higher compared to the repetitive single embryo transfer in a fresh modified natural cycle.

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“…Endometriosis is an estrogen dependent disease and COH increases estradiol concentration however according to D'Hooghe, cumulative recurrence rates are not increased after ovarian hyperstimulation for IVF [19]. Benaglia et al [20] studied 48 women with ovarian endometriomas undergoing IVF comparing cyst diameter before and 3-6 months after IVF ( Table 2).…”

Section: Recurrence or Progression Of Endometriosis After Coh For Ivfmentioning

confidence: 99%