Uticaj endometrioze na ishod vantelesne oplodnje
Impact of endometriosis on in vitro fertilization outcome
Pop-Trajković-Dinić, Sonja Z.
Faculty:Универзитет у Нишу, Медицински факултет
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Endometriosis is a frequent gynecological disease most often diagnosed in women during the reproductive years. It has been estimated that endometriosis occurs in roughly 10–15% of general population,and in women with infertility up to 40%. Endometriosis is one of the biggest challenges for gynecologists who deal with the problem of infertility. Mechanism of infertility occurence due to endometriosis is still unknown. Many factors can demonstrate the connection between infertility and endometriosis. Using the method of in-vitro fertilization (IVF), it is possible to influence some of these factors in order to improve reproductive function. However, what still is the issue of in-vitro fertilization program is a response to ovarian stimulation of patients with endometriosis. A number of controversial conclusions can be made when going through the literature on this topic. In the modern treatment of endometriosis, laparoscopic surgery is the first line treatment and is considered the "gold
standard" method of treating female infertility. The fact is that a large number of younger patients (40-50%) conceive in the first two years after a laparoscopic procedure done correctly by an experienced gynecologist. So there is still more than 50% of patients to become candidates for in-vitro fertilization, as a complementary, rather than competing method of treating marital infertility. Endometriosis in IVF treatment is a serious problem, both for gynecologists in order to obtain a greater number of egg cells, and for embryologists in order to obtain a greater number of high-quality embryos. Modern literature is facing a problem of reduced ovarian response in women operated on for endometriosis, especially in those where there is a recurrence. There is a divergence in the opinion of the authors, and various studies attempt to point out the best route. Literature reports different approaches to patients with endometriosis who enter the IVF program, in relation to age, size of the endometrioma, endometriosis stages and approach to recurrence of endometriosis. The data are controversial, and so far there are no major randomized trials that clearly indicate the impact of endometriosis on the outcome of the IVF and which would form protocols approach to patients with endometriosis who concieve through IVF program. Therefore, the aim of our study was: 1. To examine ovarian reserve in patients operated on for endometriosis, prior to entering the IVF program. 2. Assessment of ovarian response to stimulation in the IVF procedure in patients operated on for endometriosis. 3. Evaluation of IVF outcome (rates of clinical pregnancy, abortion and childbirth) in patients operated on for endometriosis. 4. The impact of (I-IV) endometriosis stage on the IVF course and outcome. 5. The impact of endometriosis recurrence on ovarian reserve, ovarian response, as well as on the course and outcome of the IVF. 6. Examine what gives higher success rate of IVF: a re-operation of endometriosis before entering the IVF program or entering into the IVF program with recurrence of endometriosis. 7. Establishment of protocols for assessment of the patients with endometriosis who are in the process of IVF. The study was conducted as a prospective-retrospective study at the Department of Gynecology and Obstetrics, Clinical Center Nish, and the Institute of Human Reproduction, Department of Gynecology and Obstetrics, Clinical Center Vojvodina, in the period from 2009. to 2012. Prospective part of the study included monitoring of the patients in the process of in-vitro fertilization (IVF), and the retrospective section applies to diagnostic procedures and surgeries before entering patients in IVF process. The study included 235 patients who had undergone the IVF program. The study group included 78 patients with endometriosis as a cause of marital infertility, and the control group of 157 patients with tubal cause of marital infertility. Certain patients underwent more than one cycle at the same clinic. For other patients, the data of previous IVF attempts, were obtained from the discharge lists from other IVF centers. After satisfying the criteria for inclusion and exclusion from the study, in all patients was observed 21defined parameter in the IVF procedure: Basal FSH, patient age, body mass index, smoking, previous pregnancy, length of infertility in age, stimulation protocol, number of ampoules used for stimulation, length of stimulation, number of follicles larger than 15 mm, number of aspirated egg cells, number of obtained embryos, number of transferred embryos, overall pregnancy rate per embryo transfer (ET), biochemical pregnancy rate per embryo transfer, clinical pregnancy rate per embryo transfer, the rate of abortion, multiple pregnancy rate, birth rate per ET, the rate of interrupted IVF cycle and the rate of hyperstimulation. All the parameters in the study group were monitored and compared to the stage and recurrence of endometriosis. In relation to the stage, patients were divided into two subgroups – I group included patients with I and II stage of endometriosis, II group included patients with III and IV stage of endometriosis. All these parameters used in research were compared between the two groups and compared with the control group. In relation to recurrence of endometriosis, the examined group of patients was divided into three subgroups: the first group consisted of patients who had undergone one surgical procedure and showed no signs of endometriosis at the moment of involvement in IVF process; the second group consisted of patients who had undergone one surgical procedure but had recurrence of endometriosis at the moment of involvement in IVF process, and the third group consisted of patients who had undergone two or more surgical procedures and showed no signs of endometriosis at the moment of involvement in IVF process. All parameters were compared among the groups and with the control group. After the resulView More
Keywords:Materica, endometrioza, infertilitet, vantelesna oplodnja, laparoskopija; endometriosis, infertility, in vitro fertilization, laparoscopic surgery