High rates of pregnancy after long-term down-regulation of women with severe endometriosis.
OBJECTIVE
The purpose of this study was to determine the effects of pituitary down-regulation for several months on the outcome of in vitro fertilization treatment in women with severe endometriosis.


METHODS
A total of 84 patients with severe endometriosis (grades III and IV) were recruited in a semirandomized prospective study; 69 of these were controls who were given a short protocol with gonadotropin-releasing hormone agonist followed by human menopausal gonadotropin and human chorionic gonadotropin to induce follicular growth. Fifteen treated patients underwent down-regulation for 2 to 7 months and then human menopausal gonadotropin and human chorionic gonadotropin to induce follicular growth. Twenty nonpregnant controls after in vitro fertilization were treated in a similar manner.


RESULTS
The pregnancy rates were much high per embryo transfer, 18 of 42 (42.8%), especially in patients in whom in vitro fertilization was carried out during the fourth month of down-regulation. Pregnancy rates in the control group were 17 of 134 (12.7%) (p < 0.001).


CONCLUSIONS
Higher rates of pregnancy are achieved after in vitro fertilization that follows long-term down-regulation in women with extensive endometriosis.
Marcus
S F
SF
Bourn Hall Clinic, Cambridge, United Kingdom.
Edwards
R G
RG
D000328:Adult; D000704:Analysis of Variance; D006063:Chorionic Gonadotropin / Q000627:therapeutic use; D015536:Down-Regulation; D004715:Endometriosis / Q000188:drug therapy*; D005260:Female; D005307:Fertilization in Vitro; D007987:Gonadotropin-Releasing Hormone / Q000627:therapeutic use*; D006801:Humans; D008596:Menotropins / Q000627:therapeutic use; D010902:Pituitary Gland / Q000187:drug effects*; D011247:Pregnancy / Q000187:drug effects*; D011256:Pregnancy Outcome; D011446:Prospective Studies; D012044:Regression Analysis; D013997:Time Factors
D006063:Chorionic Gonadotropin; D007987:Gonadotropin-Releasing Hormone; D008596:Menotropins