Is the endometriosis recurrence rate increased after ovarian hyperstimulation?
OBJECTIVE
To test the hypothesis that the cumulative endometriosis recurrence rate (CERR) after fertility surgery for endometriosis stage III or IV is increased in women exposed to very high E(2) levels during ovarian hyperstimulation (OH) for IVF when compared with women exposed to less high E(2) levels during OH for intrauterine insemination (IUI).


METHODS
Retrospective cohort study including infertility patients with endometriosis stage III or IV.


METHODS
Leuven University Fertility Center, between 1990 and 2001.


METHODS
Patients (n = 67) with endometriosis stage III (n = 45) or IV (n = 22) who underwent pelvic reconstructive surgery and subsequently started fertility treatment with either IVF only (n = 39), both IVF and IUI in different cycles (n = 11), or IUI only (n = 17).


METHODS
Life table analysis was used to calculate the CERR.


METHODS
The CERR based on histologic or cytologic proof of disease recurrence.


RESULTS
At 21 months after the start of OH the overall CERR was 31% and was significantly lower in patients treated with IVF only (7%) or women treated with both IVF and IUI in different cycles (43 %) than in those treated with IUI only (70%). At 36 months after the start of OH, the overall CERR was 63%.


CONCLUSIONS
In contrast to our hypothesis, the results from this study showed that the CERR is lower after ovarian hyperstimulation for IVF than after lower-dose ovarian stimulation for IUI, suggesting that temporary exposure to very high E(2) levels in women during OH for IVF is not a major risk factor for endometriosis recurrence in women treated with assisted reproductive technology.
D'Hooghe
Thomas M
TM
Leuven University Fertility Center, Department of Obstetrics and Gynecology, University Hospital Gasthuisberg, Leuven, Belgium. thomas.dhooghe@uz.kuleuven.ac.be
Denys
Bénédicte
B
Spiessens
Carl
C
Meuleman
Christel
C
Debrock
Sophie
S
D000328:Adult; D015331:Cohort Studies; D004715:Endometriosis / Q000150:complications* / Q000453:epidemiology / Q000601:surgery*; D004958:Estradiol / Q000097:blood; D005260:Female; D005307:Fertilization in Vitro / Q000706:statistics & numerical data; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007247:Infertility, Female / Q000209:etiology / Q000628:therapy*; D007315:Insemination, Artificial / Q000706:statistics & numerical data; D015993:Life Tables; D010062:Ovulation Induction / Q000009:adverse effects*; D019651:Plastic Surgery Procedures; D012008:Recurrence; D012189:Retrospective Studies
D004958:Estradiol