Pretreatment with dienogest in women with endometriosis undergoing IVF after a previous failed cycle

Barra, Fabio; Laganà, Antonio Simone; Scala, Carolina; Garzon, Simone; Ghezzi, Fabio; Ferrero, Simone

doi:10.1016/j.rbmo.2020.07.022

Cited by 34 publications

(36 citation statements)

References 53 publications

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“…Thus, various modified and personalized ovarian stimulation strategies were adopted by infertile patients to improve the outcomes. Previous studies reported that the IVF outcomes of patients with endometriosis were improved by pretreatment with DNG, and myo-inositol is of proven utility in those with PCOS [ 45 , 46 ]. Our centre also published some work in this field on the basis of a novel ovarian stimulation strategy named progestin primed ovarian stimulation (PPOS) [ 15 , 47 , 48 ].…”

Section: Discussionmentioning

confidence: 99%

Does the cell number of 0PN embryos on day 3 affect pregnancy and neonatal outcomes following single blastocyst transfer?

Chen

Yin

et al. 2022

BMC Pregnancy Childbirth

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Background 0PN zygotes have a low cleavage rate, and the clinical outcomes of cleavage-stage embryo transfers are unsatisfactory. Blastocyst culturing is used to screen 0PN embryos, but whether the cell number of 0PN embryos on day 3 affects the clinical outcomes following single blastocyst transfer is unknown and would be helpful in evaluating the clinical value of these embryos. Methods This retrospective study compared 46,804 0PN zygotes, 242 0PN frozen-thawed single blastocyst transfers, and 92 corresponding 0PN singletons with 232,441 2PN zygotes, 3563 2PN frozen-thawed single blastocyst transfers, and 1250 2PN singletons from January 2015 to October 2019 at a tertiary-care academic medical centre. The 0PN and 2PN embryos were divided into two groups: the group with < 6 cells on day 3 and that with ≥ 6 cells. Embryo development, subsequent pregnancy and neonatal outcomes were compared between the two groups. Results The cleavage and available blastocyst rates of the 0PN zygotes were much lower than those of the 2PN zygotes (25.9% vs. 97.4%, P < 0.001; 13.9% vs. 23.4%, P < 0.001). In the < 6 cells group, the available blastocyst rate of the cleaved 0PN embryos was significantly lower than that of the 2PN embryos (2.5% vs. 12.7%, P < 0.001). However, in the ≥ 6 cells group, the available blastocyst rate of the 0PN cleaved embryos significantly improved, although it was slightly lower than that of the 2PN embryos (33.9% vs. 35.7%, P = 0.014). Importantly, compared to those of the 2PN single blastocyst transfers, the clinical pregnancy rate, live birth rate, Z-score and malformation rate of the 0PN single blastocyst transfers were not significantly different in either the < 6 cells group (30.4% vs. 39.8%, P = 0.362; 30.4% vs. 31.3%, P = 0.932; 0.89 ± 0.90 vs. 0.42 ± 1.02, P = 0.161; 0% vs. 2.6%, P = 1.000) or the ≥ 6 cells group (50.7% vs. 46.6%, P = 0.246; 39.7% vs. 38.3%, P = 0.677; 0.50 ± 1.23 vs. 0.47 ± 1.11, P = 0.861; 2.4% vs. 1.8%, P = 1.000). Conclusions The cell number on day 3 of 0PN embryos affected the subsequent formation of blastocysts but did not influence the subsequent pregnancy and neonatal outcomes of 0PN single blastocyst transfers, which may be beneficial to clinicians counselling patients on the clinical value of 0PN embryos.

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Section: Discussionmentioning

confidence: 99%

Does the cell number of 0PN embryos on day 3 affect pregnancy and neonatal outcomes following single blastocyst transfer?

Chen

Yin

et al. 2022

BMC Pregnancy Childbirth

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“…In patients with endometriosis, pretreatment with dienogest has proved to yield better oocyte retrieval, good blastocysts in patients and IVF outcome has also been seen to improve with dienogest. There are controversies regarding this when patients with moderate and severe endometriosis are taken into consideration, where no improvement is seen in clinical pregnancy outcome with administration of dienogest as pretreatment of IVF [16]. In our study 18.52% patients with early asymptomatic endometriosis, had conceived spontaneously after treatment with dienogest for 3 months and 37.04% had conceived after treating them with dienogest followed by letrozole for subsequent 3-6months.…”

Section: Results Discussionmentioning

confidence: 57%

Judicial medical management of mild and minimal endometriosis in selected patients of infertility is non-inferior to surgical treatment – a retrospective analysis

Siddhartha¹,

Bishista²,

Arpan³

2022

Arch Clin Obs Gyn Res

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Background: Endometriosis is an enigmatic disease that affects approximately 10% of women of reproductive age and almost 50% of women with endometriosis experience infertility. These women experience symptoms of dysmenorrhea, premenstrual pain, dyspareunia, and infertility, but many affected women are asymptomatic. Objective: To analyse the clinical pregnancy rate after treating mild and minimal endometriosis causing infertility with dienogest (2 mg) or by surgical intervention. Materials and Methods: 146 subfertile women with mild and minimal endometriosis, enrolled over a period of 36 months (January 2017 to December 2019) at Calcutta Fertility Mission have been included in the present study. They were grouped in A and B and treated with dienogest (2mg) for 90days or by laparoscopic ablation, and ovulation induction. Clinical pregnancy rates were analysed. Results: In our study, 18.52% of patients with early stage asymptomatic endometriosis, had conceived spontaneously after treatment with dienogest for 3 months, and 37.04%, 44.44% had conceived after treating them with dienogest followed by letrozole and letrozole and GnRH, for subsequent 3-6months, respectively. 13.64% , 36.36% , 50% of women had conceived spontaneously after laparoscopic ablation, after treating them with ablative procedure and letrozole and with letrozole and GnRH in the next 3-6 cycles, respectively. Spontaneous pregnancy and pregnancy following letrozole only or letrozole and GnRH in Group A and B were also not statistically significant (p - 0.961, p - 0.698). Conclusion: Clinical pregnancy in infertile women with early endometriosis treated with dienogest is non-inferior to others treated with laparoscopic ablation and minimal adhesiolysis.

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“…Furthermore, the lack of sequential endometrial samples from the same patients prevents us from establishing whether the alterations in α-inhibin and betaglycan precede or follow other changes in markers of endometrial differentiation during the secretory phase. A strength of the study is the fact that the participants were not using hormonal treatments, which are known to modify not only the gross morphology but also the molecular profile of the endometrium [33][34][35].…”

Section: Discussionmentioning

confidence: 99%

Altered Endometrial Expression of α-Inhibin Subunit and Its Co-Receptor Betaglycan in Infertile Women with Endometriosis

Cruz

Vilamil

Casalechi

et al. 2022

Gynecol Obstet Invest

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Background: Inhibins and their co-receptor betaglycan are members of the transforming growth factor β superfamily, a group of signaling molecules that control the differentiation of human endometrium in the secretory phase of the menstrual cycle. Objective: Since endometriosis is associated with endometrial dysfunction and infertility, this study aimed at evaluating the expression of α-inhibin and betaglycan mRNA and proteins in endometrial samples of infertile women with and without endometriosis. Design: This was a cross-sectional study. Participants/Materials: Endometrial samples of women with (n = 17) and without (n = 22) endometriosis were subdivided according to the menstrual cycle phase into proliferative and secretory. Setting: University hospital. Methods: We used real-time RT-PCR to quantify mRNA levels and immunohistochemistry to localize the proteins. Results: α-inhibin mRNA levels were significantly increased in the secretory phase (p < 0.01 vs. proliferative phase) only among women with endometriosis. Conversely, betaglycan mRNA levels were downregulated in the secretory endometrium of controls (p < 0.01 vs. proliferative) but failed to change between cycle phases of patients with endometriosis. Both proteins were present in the glandular epithelium and stroma in the endometrium of women with and without endometriosis. Immunostaining analysis showed that while α-inhibin protein expression did not vary significantly, the intensity of betaglycan immunostaining decreased in the secretory phase in the control group (p = 0.038 vs. proliferative phase) but not in the endometriosis group. Limitations: We cannot determine whether endometriosis causes the abnormal expression of α-inhibin and betaglycan in the eutopic endometrium or if this alteration already existed before the establishment of endometriotic lesions. Conclusion: Our findings suggest an abnormally increased expression of α-inhibin mRNA (not protein) and betaglycan (mRNA and protein) in the secretory-phase endometrium of women with endometriosis.

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Pretreatment with dienogest in women with endometriosis undergoing IVF after a previous failed cycle

Cited by 34 publications

References 53 publications

Does the cell number of 0PN embryos on day 3 affect pregnancy and neonatal outcomes following single blastocyst transfer?

Does the cell number of 0PN embryos on day 3 affect pregnancy and neonatal outcomes following single blastocyst transfer?

Judicial medical management of mild and minimal endometriosis in selected patients of infertility is non-inferior to surgical treatment – a retrospective analysis

Altered Endometrial Expression of α-Inhibin Subunit and Its Co-Receptor Betaglycan in Infertile Women with Endometriosis

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