Natural cycle IVF in unexplained, endometriosis-associated and tubal factor infertility.
BACKGROUND
To elucidate possible differences between unexplained and minimal peritoneal endometriosis-associated infertility, we studied their outcome in natural cycle IVF (NIVF).


METHODS
A prospective cohort study was carried out on unexplained (33 couples), minimal peritoneal endometriosis-associated (30 couples) and tubal factor (24 couples) infertility in 223 NIVF cycles, using human chorionic gonadotrophin (HCG) for ovulation induction.


RESULTS
During the first NIVF attempt, follicular and luteal phase oestradiol, FSH, LH and progesterone concentrations, as well as endometrial thickness and follicular diameter were similar among the three groups. Periovulatory follicular growth monitored from day of HCG administration to oocyte aspiration was significantly lowered in unexplained infertility compared with minimal endometriosis-associated and tubal factor infertility. The fertilization rate, clinical pregnancy rate per initiated cycle, per successful oocyte retrieval and per embryo transfer, in minimal endometriosis (80.0, 10.4, 16.0 and 23.5% respectively) were similar to that in tubal factor infertility patients (68.6, 5.8, 11.4 and 16.0%) but significantly higher (P < 0.05) than that of the unexplained infertility group (62.2, 2.6, 5.4 and 8.7%).


CONCLUSIONS
The significant reduction in follicular periovulatory growth, fertilization and pregnancy rates in unexplained infertility compared with minimal peritoneal endometriosis patients may be explained by sub-optimal follicular development with possibly reduced oocyte quality, intrinsic embryo quality factors or by impaired implantation. From a clinical point of view, NIVF is less suited to unexplained infertility treatment, but might represent an interesting treatment option for minimal peritoneal endometriosis-associated infertility.
Omland
A K
AK
Department of Obstetrics and Gynaecology, National Hospital, University of Oslo, Oslo, Norway. anne.omland@riskhospitalet.no
Fedorcsák
P
P
Storeng
R
R
Dale
P O
PO
Abyholm
T
T
Tanbo
T
T
D000328:Adult; D015331:Cohort Studies; D004715:Endometriosis / Q000150:complications* / Q000473:pathology; D004717:Endometrium / Q000473:pathology; D004958:Estradiol / Q000097:blood; D005184:Fallopian Tube Diseases / Q000150:complications* / Q000473:pathology; D005260:Female; D005307:Fertilization in Vitro / Q000379:methods*; D005640:Follicle Stimulating Hormone / Q000097:blood; D005498:Follicular Phase; D006801:Humans; D007246:Infertility / Q000628:therapy*; D007247:Infertility, Female / Q000209:etiology* / Q000473:pathology / Q000628:therapy*; D008183:Luteal Phase; D007986:Luteinizing Hormone / Q000097:blood; D008297:Male; D006080:Ovarian Follicle / Q000473:pathology; D011247:Pregnancy; D011374:Progesterone / Q000097:blood; D011446:Prospective Studies; D016896:Treatment Outcome
D011374:Progesterone; D004958:Estradiol; D007986:Luteinizing Hormone; D005640:Follicle Stimulating Hormone