Pretreatment of Dienogest for Women with Endometriosis in in vitro Fertilization: A Systematic Review and Meta-Analysis

Abstract

Introduction Dienogest (DNG) was demonstrated to be comparable to gonadotropin-releasing hormone agonist (GnRH-a) in controlling symptoms of endometriosis. GnRH-a is used before in vitro fertilization (IVF) in women with endometriosis to improve pregnancy outcomes. We aimed to determine the effect of DNG pretreatment on IVF outcomes, including number of mature oocytes, rate of clinical pregnancies, and rate of live births in women with endometriosis. Methods All studies involving DNG, IVF and endometriosis were searched from the PubMed, Ovid/MEDLINE, Wanfang, CQVIP, China National Knowledge Infrastructure databases and ClinicalTrials.gov. The study population was women with endometriosis in IVF. Randomized controlled trials and cohort studies were included. All included studies comprised a DNG group and a control group. The outcomes were number of mature oocytes, rate of clinical pregnancies and rate of live births. We calculated the odds ratio or mean difference, and 95% confidence interval for each study, and used a random-effects model to estimate the results. Results Five articles were screened by the search strategy. One article without a control group was excluded. Finally, four articles with 422 patients were included. No significant differences in number of mature oocytes (MD=-1.27, 95% CI=-3.63-1.09, I²=91%), the rate of clinical pregnancies (odds ratio = 1.07, 95% CI = 0.33–3.47, I² = 84%) or the rate of live births (odds ratio =1.13, 95% CI=0.37‐3.45, I²=83%) were found between the DNG group and the control group. Conclusion Pretreatment with DNG for women with endometriosis who underwent IVF could not improve the number of mature oocytes, the rate of clinical pregnancies or the rate of live births.

Perioperative hormone treatment of endometriosis

“…Amongst those patients who have DNG ahead of ART, there has been no evidence to suggest benefit over GnRHa [18] or placebo [24] for pregnancy and ART outcomes. However, the DNG has a lower cost of treatment with reduced side effect and better tolerability compared with GnRHa [18].…”

Exploring the Impact of Endometrioma Aspiration and Dienogest Combination Therapy on Cyst Size, Inflammatory Cytokines in Follicular Fluid and Fertility Outcomes

“…Although the recurrence of endometriomas is a common drawback of aspiration, studies have shown that combining the use of gonadotropin-releasing hormone (GnRH) agonists and multiple aspirations can reduce the frequency of recurrence and improve ART outcomes [ 19 , 20 ]. Hormonal therapies, such as GnRH agonists [ 21 , 22 ] and the progestin dienogest (DNG) [ 23 ] administered prior to ART have also been reported to enhance clinical pregnancy rates, but recent systematic reviews have debunked the effects of GnRH agonists [ 24 ] and DNG [ 25 ], suggesting that it is difficult to expect that drugs alone can improve ART outcomes in endometriosis patients.…”