Oocyte vitrification for fertility preservation in women with endometriosis: an observational study

Abstract

Objective: To describe the outcome of fertility preservation (FP) using vitrified oocytes in patients with endometriosis and to determine the impact of ovarian surgery. Design: Retrospective observational study. Setting: University-affiliated private in vitro fertilization (IVF) center. Patient(s): Four hundred and eighty-five women with endometriosis who underwent FP from January 2007 to July 2018. Intervention(s): Vitrification of metaphase II (MII) oocytes for future use. Main Outcome Measure(s): Oocyte survival rate and cumulative live-birth rate (CLBR). Result(s): Mean age at vitrification was 35.7 AE 3.7 years. The women undergoing operations were younger than the nonsurgical patients (33.4 AE 3.6 years vs. 36.7 AE 3.7 years). The survival rate and CLBR were 83.2% and 46.4%, respectively. The number of vitrified oocytes per cycle (6.2 AE 5.8) was higher for the nonsurgical patients compared with the unilateral (5.0 AE 4.5) or bilateral (4.5 AE 4.4) surgery groups, but was comparable among the surgical patients. The effect of age (adjusted odds ratio [OR] 0.904; 95% CI, 0.858-0.952), number of oocytes (adjusted OR 1.050; 95% CI, 1.025-1.091), and survival (adjusted OR 1.011; 95% CI, 1.001-1.020) on the CLBR was confirmed. However, the effect of surgery was not observed (adjusted OR 1.142; 95% CI, 0.778-1.677). Nonetheless, the ovarian response (vitrified oocytes ¼ 8.6 AE 6.9 vs. 5.1 AE 4.8) and CLBR (72.5% vs. 52.8%) were higher in young (%35 years) nonsurgical patient versus the surgical patients; older women showed similar outcomes. Conclusion(s):Fertility preservation gives patients with endometriosis a valid treatment option to help them increase their reproductive chances. We suggest performing surgery after ovarian stimulation for FP in young women. In older women, an individualized treatment should be considered. (Fertil Steril Ò 2020;113:836-44. Ó2019 by American Society for Reproductive Medicine.) El resumen está disponible en Español al final del artículo.

Number needed to freeze: cumulative live birth rate after fertility preservation in women with endometriosis

“…Fertility preservation is increasingly considered an alternative for patients diagnosed with endometriosis who are at risk of compromised ovarian reserve. The usefulness of oocyte vitrification for FP in women with endometriosis was recently demonstrated in a large study which also confirmed the impact of age, number of oocytes and egg survival on the cumulative live birth rate (Cobo et al, 2020). Furthermore, the study showed that young women achieved better outcomes when they had oocytes vitrified for FP prior to the excision of ovarian endometrioma.…”

“…Furthermore, the study showed that young women achieved better outcomes when they had oocytes vitrified for FP prior to the excision of ovarian endometrioma. The number of oocytes retrieved, therefore the number of metaphase II (MII) available for vitrification, was lower in operated women (Cobo et al, 2020). The recognition of number of oocytes stored and patient age as key factors for success brings forth the question regarding the appropriate number of oocytes to vitrify.…”

“…Baseline characteristics and overall clinical outcomes when women attempted pregnancy with their vitrified-warmed oocytes were provided (Cobo et al, 2020). The inclusion criteria for fertility preservation were: age up to 42 y., endometrioma larger than 1 cm in mean diameter with apparently healthy ovarian tissue (antral follicles) visible in the 2D ultrasound, and AMH >0.5 ng/ml and >3 antral follicles.…”

“…Main concerns relate to the lack of evidence regarding the efficiency of FP in this specific population and the lack of knowledge regarding the quality of the vitrified oocytes and their ability to generate viable pregnancies in this group of women, all this added to the absence of cost-effectiveness studies (Somigliana et al, 2015). We recently published a large study including women diagnosed with endometriosis who had their oocytes vitrified for FP and returned to attempt pregnancy (Cobo et al, 2020). The study confirmed the usefulness of FP in managing future fertility expectations in endometriosis patients, showing efficient oocyte survival and clinical results after vitrification.…”

Socio-Economic Factors of Empowerment in Developing Countries

“…In this research the fertility rate of 2014 taking as for dependent variable and other five independent variable like democracy, health, Economically view, education and political situation. Samari (2019) In the second stage of the dependent variable is taking from the fertility rate of 2013 same as independent variables in 2013 and in third stage taking the sum of dependent variable 2014 and 2013 and apply robust test (Phelippeau, Cazalis, & Koskas, 2019;Wu, Satmary, Peng, & Hui, 2020) Human development report, UNDP and World Bank 2015 data bases, Polity data scores data sheet, are the sources of data collection for all the indicators and variables of study (Cobo et al, 2020;Sciorio & Anderson, 2019;Tierney, 2020).…”