Cycle-specific and cumulative fecundity in patients with endometriosis who are undergoing controlled ovarian hyperstimulation-intrauterine insemination or in vitro fertilization-embryo transfer.
OBJECTIVE
To compare controlled ovarian hyperstimulation-intrauterine insemination (COH-IUI) or IVF-ET pregnancy rates per cycle (PR) and cycle and cumulative fecundity (f and cf) with COH-IUI or IVF-ET in endometriosis.


METHODS
Retrospective analysis.


METHODS
Endometriosis research institute.


METHODS
Women with endometriosis and infertility (n = 313) who underwent consecutive COH-IUI (202 patients, 648 cycles), IVF-ET (111 patients, 139 cycles), or IVF-ET after failed COH-IUI (56 patients, 68 cycles).


METHODS
None.


METHODS
Crude PR and life table-estimated f and cf.


RESULTS
With COH-IUI, 69 patients conceived; 65 conceived with IVF-ET; and 30 conceived with IVF-ET after COH-IUI (PR 11%, 47%, and 44%). With COH-IUI, six-cycle cf was 41%, and f for cycles 1-6 was 15%, 12%, 8%, 7%, 7%, and 0. With IVF-ET, three-cycle cf was 73%, whereas f for cycles 1-3 was 47%, 27%, and 33%. First-cycle f with IVF-ET was significantly higher than cf of six COH-IUI cycles. When the data were stratified according to the stage of endometriosis and women's age, the benefit of IVF over COH was even more pronounced. Prior COH-IUI failure did not adversely affect IVF-ET outcome.


CONCLUSIONS
In endometriosis, PR, f, and cf are significantly higher with IVF-ET than COH-IUI, especially in stage IV and in women >38 years of age. Considering adverse effects of prolonged ovarian stimulation on endometriosis, IVF-ET should be the first-line approach in the management of infertility in this disease. If COH-IUI is attempted, it should not exceed three to four cycles.
Dmowski
W Paul
WP
Institute for the Study and Treatment of Endometriosis, Oak Brook, Illinois, USA. wpdmowski@oakbrookfertility.com
Pry
Michelle
M
Ding
Jianchi
J
Rana
Nasir
N
D000328:Adult; D006063:Chorionic Gonadotropin / Q000008:administration & dosage; D015925:Cryopreservation; D010064:Embryo Implantation; D004624:Embryo Transfer; D004715:Endometriosis / Q000150:complications* / Q000601:surgery; D004958:Estradiol / Q000097:blood; D005260:Female; D005307:Fertilization in Vitro; D006801:Humans; D007247:Infertility, Female / Q000209:etiology / Q000628:therapy*; D007317:Insemination, Artificial, Homologous; D010062:Ovulation Induction; D011247:Pregnancy
D006063:Chorionic Gonadotropin; D004958:Estradiol