title: Efficacy and safety of IVF/ICSI in patients with severe endometriosis after long-term pituitary down-regulation.
abstract: Long-term pituitary down-regulation with a gonadotrophin-releasing hormone (GnRH) agonist for 3–6 months prior to IVF/intracytoplasmic sperm injection (ICSI) improves clinical pregnancy rates in endometriosis patients. However, some discussion about this treatment strategy still exists. This retrospective study from a tertiary-care university hospital examined the efficacy and safety of IVF/ICSI with and without long-term pituitary down-regulation in severe endometriosis patients (surgically confirmed American Society for Reproductive Medicine stages III and IV). All first IVF/ICSI treatment cycles between January 2009 and January 2012 were analysed. In patients treated with (n = 68) and without (n = 45) long-term pituitary down-regulation, 13 (19.1%) versus nine (20.0%) ongoing pregnancies after fresh embryo transfer (adjusted OR 0.58, 95% CI 0.18–1.86,) and 24 (35.3%) versus 10 (22.2%) ongoing pregnancies after fresh and cryopreserved embryo transfers (adjusted OR 1.62, 95% CI 0.60–4.38) were accomplished, respectively. Three complications (2.7%) and three recurrences (2.7%) were reported, only in patients treated with long-term pituitary down-regulation. The 1-year cumulative endometriosis recurrence rate was 7.3%. IVF/ICSI in patients with severe endometriosis is safe with low complication and recurrence rates. A favourable effect, albeit non-significant, of long-term pituitary down-regulation in achieving an ongoing pregnancy was observed only after including cryopreserved embryo transfers.
authors.affiliation: Division of Reproductive Medicine, Department of Obstetrics and Gynaecology, VU University Medical Center, Amsterdam, The Netherlands. Electronic address: l.vanderhouwen@vumc.nl.
authors.forename: Lisette E E
authors.initials: LE
authors.lastname: van der Houwen
authors.affiliation: Division of Reproductive Medicine, Department of Obstetrics and Gynaecology, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Velja
authors.initials: V
authors.lastname: Mijatovic
authors.affiliation: Division of Reproductive Medicine, Department of Obstetrics and Gynaecology, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Elmer
authors.initials: E
authors.lastname: Leemhuis
authors.affiliation: Division of Reproductive Medicine, Department of Obstetrics and Gynaecology, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Roel
authors.initials: R
authors.lastname: Schats
authors.affiliation: Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Martijn W
authors.initials: MW
authors.lastname: Heymans
authors.affiliation: Division of Reproductive Medicine, Department of Obstetrics and Gynaecology, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Cornelis B
authors.initials: CB
authors.lastname: Lambalk
authors.affiliation: Division of Reproductive Medicine, Department of Obstetrics and Gynaecology, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Peter G A
authors.initials: PG
authors.lastname: Hompes
mesh_terms: D015536:Down-Regulation; D004715:Endometriosis / Q000188:drug therapy*; D005260:Female; D005307:Fertilization in Vitro / Q000379:methods / Q000592:standards*; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists*; D006801:Humans; D016729:Leuprolide / Q000494:pharmacology*; D015993:Life Tables; D016015:Logistic Models; D010902:Pituitary Gland / Q000187:drug effects*; D011247:Pregnancy; D018873:Pregnancy Rate; D012008:Recurrence; D012189:Retrospective Studies; D020554:Sperm Injections, Intracytoplasmic / Q000379:methods / Q000592:standards*; D018709:Statistics, Nonparametric; D016896:Treatment Outcome
chemical_list: D007987:Gonadotropin-Releasing Hormone; D016729:Leuprolide
keywords: IVF; complication; endometriosis; long-term pituitary down-regulation; ongoing pregnancy rate; recurrence