Does controlled ovarian hyperstimulation in women with a history of endometriosis influence recurrence rate?
BACKGROUND
Endometriosis is a common estrogen-dependent disease. The aim of this study was to assess whether controlled ovarian hyperstimulation (COH) for assisted reproductive technology (ART) was associated with an increased incidence in endometriosis recurrence as documented by transvaginal ultrasound (TV-US).


METHODS
In a retrospective cohort study of 592 patients submitted to laparoscopy for endometriosis, 177 with infertility-related endometriosis who underwent a periodic ultrasound follow-up after laparoscopy were selected. Women who started ART after laparoscopy (n = 90) were compared with the control group, who did not undergo ART (n = 87). Recurrence of endometriosis was defined as the presence of endometriotic lesions observed through TV-US.


RESULTS
During a long-term TV-US follow-up (1-15 years), 40 (22.6%) recurrences were observed. Patients submitted to ART showed a cumulative recurrence rate similar to that of the control group (28.6% and 37.9% respectively, p = 0.471). Recurrent lesions were ovarian cysts (47.5%), ovarian nodules (37.5%), and rectovaginal disease (15%). The stratified analysis based on stages of endometriosis and pelvic pain did not show differences.


CONCLUSIONS
Gonadotropin treatments do not seem to affect the natural history of endometriotic lesions. The most important prognostic factors in recurrent disease observed by TV-US seem to be the stage of endometriosis and the presence of pelvic pain at the time of the first laparoscopic treatment.
Coccia
Maria Elisabetta
ME
Department of Gynaecology, Perinatology and Human Reproduction, University of Florence, Florence, Italy. cocciame@tin.it
Rizzello
Francesca
F
Gianfranco
Scarselli
S
D000328:Adult; D006063:Chorionic Gonadotropin / Q000009:adverse effects* / Q000627:therapeutic use; D015331:Cohort Studies; D004715:Endometriosis / Q000150:complications* / Q000601:surgery; D005260:Female; D005640:Follicle Stimulating Hormone / Q000627:therapeutic use; D005500:Follow-Up Studies; D006801:Humans; D007247:Infertility, Female / Q000209:etiology / Q000628:therapy*; D007279:Injections, Subcutaneous; D010535:Laparoscopy; D010062:Ovulation Induction / Q000009:adverse effects*; D011247:Pregnancy; D018873:Pregnancy Rate; D012008:Recurrence; D012099:Reproductive Techniques; D012189:Retrospective Studies; D017329:Triptorelin Pamoate / Q000627:therapeutic use
D006063:Chorionic Gonadotropin; D017329:Triptorelin Pamoate; D005640:Follicle Stimulating Hormone