The clinical outcome of Dienogest treatment followed by in vitro fertilization and embryo transfer in infertile women with endometriosis

Abstract

BackgroundEndometriosis is considered to be the most intractable cause of female infertility. Administering any type of treatment for endometriosis before in vitro fertilization and embryo transfer (IVF-ET) is an important strategy for improving the IVF-ET outcomes for infertile women with endometriosis. In fact, treatment with a gonadotropin-releasing hormone (GnRH) agonist just before IVF-ET has been reported to improve the clinical outcome in endometriosis patients. However, the benefit of Dienogest (DNG), a synthetic progestin, treatment just before IVF-ET remains unclear.MethodsSixty-eight infertile women with Stage III or IV endometriosis (ovarian endometrial cyst < 4 cm) were recruited for this study. The subjects were divided into 2 groups: a DNG group (n = 33) and a control group (n = 35). DNG was administered orally every day for 12 weeks prior to the conventional IVF-ET cycle in the DNG group. Standard controlled ovarian hyperstimulation with the GnRH agonist long protocol was performed in the control group. The numbers of mature follicles and retrieved oocytes, fertilization rates, implantation rates, and clinical pregnancy rate were compared between the two groups. In addition, the concentrations of inflammatory cytokines, oxidative stress markers, and antioxidants in follicular fluids were also measured.ResultsThe numbers of growing follicles, retrieved oocytes, fertilized oocytes, and blastocysts were significantly lower in the DNG group than in the control group. The fertilization and blastocyst rates were also lower in the DNG group than in the control group. Although there was no significant difference in the implantation rate between the groups, the cumulative pregnancy rate and live birth rate were lower in the DNG group than in the control group. There was no significant difference in the abortion rate. Our results failed to show that DNG reduces the inflammatory cytokine levels and oxidative stress in follicular fluids.ConclusionsAdministering DNG treatment just before IVF-ET did not provide any benefits to improve the clinical outcomes for infertile women with endometriosis.

Ovarian reserve after three-step laparoscopic surgery for endometriomas utilizing dienogest: a non-randomized prospective pilot study.

“…On the other hand, suppressive hormonal medication in women with endometriosis may not have bene t in terms of pregnancy rate [2]. Moreover, the administration of dienogest before the follicle aspiration in IVF in women with endometriomas did not show signi cant bene t [21]. In the view of infertility treatment, peri-operative medication should be minimized.…”

Role of suppression of endometriosis with progestins before IVF-ET: a non-inferiority randomized controlled trial

“…Recently, another RCT had shown that Dienogest pretreatment for patients with endometriosis before IVF was associated with a significantly lower number of oocytes retrieved and worse pregnancy outcomes [ 16 ]. Despite similarities in design, there are important differences between this trial and our study.…”

“…This has led to the use of Dienogest for control of pelvic pain due to endometriosis with beneficial and comparable effect to depot GnRHa [ 11 , 13 – 15 ]. However, its role in suppressing the endometriotic lesions before IVF treatment and its impact on IVF outcome is still unclear [ 16 , 17 ].…”

Ovarian reserve after three‐step laparoscopic surgery for endometriomas utilizing dienogest: A pilot study

“…On the other hand, suppressive hormonal medication in women with endometriosis may not have benefit in terms of pregnancy rate 2 . Moreover, the administration of dienogest before the follicle aspiration in IVF in women with endometriomas did not show significant benefit 21 . In the view of infertility treatment, peri‐operative medication should be minimized.…”