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Yang, Kim, Sung, Ahn, Choo, Yang, Song, Koong, and Kang: In vitro fertilization outcomes in patients with advanced endometriosis after surgical treatment
Original Article
Korean Journal of Obstetrics & Gynecology

Korean Journal of Obstetrics & Gynecology 2011; 54(9): 517-522.

Published online: 26 September 2011

DOI: https://doi.org/10.5468/KJOG.2011.54.9.517

In vitro fertilization outcomes in patients with advanced endometriosis after surgical treatment

Seung Heon Yang, MD, Hye Ok Kim, MD, Na Young Sung, MD, Hyun Suk Ahn, MD, Youn Sil Choo, MD, Kwang Moon Yang, MD, In Ok Song, MD, Mi Kyoung Koong, MD, Inn Soo Kang, MD

Department of Obstetrics and Gynecology, Cheil General Hospital, Kwandong University College of Medicine, Seoul, Korea.

Corresponding author: Hye Ok Kim, MD. Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Cheil General Hospital & Women's Healthcare Center, Kwandong University College of Medicine, 1-19 Mukjeong-dong, Jung-gu, Seoul 100-380, Korea. Tel: +82-2-2000-4738, Fax: +82-2-2000-7790, ok58163@hanmail.net

Received 2 March 2011       Revised 27 May 2011       Accepted 4 July 2011

Copyright © 2011. Korean Society of Obstetrics and Gynecology

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objective

The aim of this study is to evaluate in vitro fertilization (IVF) outcomes in advanced endometriosis with/without surgical treatment and to compare between cyst enucleation and surgically treated peritoneal lesions without endometrioma.

Methods

We performed a retrospective analysis of 506 IVF cycles (345 patients) with stage III-IV endometriosis (170 cycles without surgical treatment, 336 cycles with the surgical treatment) between 1997 and 2004. Among the surgical treatment, 151 cycles were performed previously cyst enucleation with endometrioma and 185 cycles were performed only resection of peritoneal lesions without endometrioma enucleation. 313 cycles (246 patients) with the tubal factor infertility were used as controls.

Results

In the endometriosis group with/without surgical treatment, the number of retrieved oocytes (9.6 ± 7.3 vs. 11.2 ± 7.5 vs. 14.8 ± 7.0, P < 0.0001) and the transferred embryos (3.5 ± 1.4 vs. 3.5 ± 1.4 vs. 3.9 ± 0.9, P = 0.001) was significantly lower than controls. But, implantation rates (17.2% vs. 15.2% vs. 15.9%), pregnancy rates (36.9% vs. 35.9% vs. 39.6%) and live birth rates (32.1% vs. 28.2% vs. 29.7%) were similar. Surgically treated peritoneal lesions group showed no difference in the number of retrieved oocytes (9.6 ± 7.9 vs. 9.8 ± 6.5), the number of transferred embryos (3.4 ± 1.4 vs. 3.7 ± 1.3), implantation rates (15.5% vs. 18.0%), pregnancy rates (34.6% vs. 39.7%) and live birth rates (29.2% vs. 35.8%) with cyst enucleation group.

Conclusion

IVF parameters in the patients with endometriosis are inferior to tubal factor infertility, but IVF outcomes are comparable. Surgically treated peritoneal lesions group without endometrioma enucleation shows IVF parameters as bad as cyst enucleation group. We might be considered endometriosis itself worse IVF parameters regardless previous cyst enucleation.

Keywords: Endometriosis, Peritoneal, In vitro Fertilization, Cyst enucleation, Infertility

Figures and Tables

Table 1
Demographic characteristics of patients with tubal factor and advanced endometriosis associated infertility
kjog-54-517-i001

Values are mean ± standard deviation or number (%).

NA, not applicable; FSH, follicle stimulating hormone; IVF, in vitro fertilization.

aP < 0.0001, compared to tubal factor and treated endometriosis infertility.

bP < 0.0001, cP = 0.006, eP < 0.0001 compared to tubal factor infertility.

dP = 0.04, compared to surgically treated endometriosis.

Table 2
IVF parameters and outcomes in tubal factor and advanced endometriosis associated infertility with/without surgical treatment
kjog-54-517-i002

Values are mean ± standard deviation or number (%).

IVF, in vitro fertilization; E2, estradiol; hCG, human chorionic gonadotropin; No, number; ICSI, intracytoplasmic sperm injection.

aP = 0.008, c,d,e,g,h,kP < 0.0001, i,jP = 0.001 compared to tubal factor infertility.

bP = 0.001, fP = 0.002 compared to surgically treated endometriosis.

Table 3
IVF parameters and outcomes in patients with endometriosis between cyst enucleation and peritoneal lesions only without endometrioma after surgical treatment
kjog-54-517-i003

Values are mean ± standard deviation or number (%).

IVF, in vitro fertilization; E2, estradiol; hCG, human chorionic gonadotropin; NS, not significant; No, number.

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