title: Is the endometriosis recurrence rate increased after ovarian hyperstimulation?
abstract: 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.
authors.affiliation: Leuven University Fertility Center, Department of Obstetrics and Gynecology, University Hospital Gasthuisberg, Leuven, Belgium. thomas.dhooghe@uz.kuleuven.ac.be
authors.forename: Thomas M
authors.initials: TM
authors.lastname: D'Hooghe
authors.forename: Bénédicte
authors.initials: B
authors.lastname: Denys
authors.forename: Carl
authors.initials: C
authors.lastname: Spiessens
authors.forename: Christel
authors.initials: C
authors.lastname: Meuleman
authors.forename: Sophie
authors.initials: S
authors.lastname: Debrock
mesh_terms: 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
chemical_list: D004958:Estradiol