Determining the fertility benefit of controlled ovarian hyperstimulation with intrauterine insemination after operative laparoscopy in patients with endometriosis
| Autor: | Tommaso Falcone, Anjalika R. Gandhi, Luiz Carvalho, Benjamin Nutter |
|---|---|
| Rok vydání: | 2013 |
| Předmět: |
Infertility
Adult medicine.medical_specialty Pregnancy Rate Endometriosis Controlled ovarian hyperstimulation Ovulation Induction Pregnancy medicine Humans Stage (cooking) Laparoscopy Insemination Artificial Retrospective Studies Gynecology medicine.diagnostic_test business.industry Obstetrics Letrozole Obstetrics and Gynecology Retrospective cohort study medicine.disease Female business Infertility Female medicine.drug |
| Zdroj: | Journal of minimally invasive gynecology. 21(1) |
| ISSN: | 1553-4669 |
| Popis: | Study Objective To determine the fertility benefit of controlled ovarian hyperstimulation (COH) and intrauterine insemination (IUI) in surgically treated endometriosis. Design Retrospective cohort study (Canadian Task Force classification II-2). Setting Cleveland Clinic Foundation, tertiary care center. Patients Ninety-six women of reproductive age who underwent operative laparoscopy to treat endometriosis-related infertility (endometriosis stage I/II n = 67; stage III/IV n = 29) from 2001 to 2011 at the Cleveland Clinic Foundation. Interventions COH via letrozole, clomiphene, or gonadotropins, with or without IUI. Measurements and Main Results Kaplan-Meier estimations of cumulative pregnancy rates were compared by stage between COH/IUI and spontaneous cycles. Patients with stage I/II endometriosis attempted spontaneous pregnancy for 669 months and 216 COH + IUI cycles, and patients with stage III/IV endometriosis attempted spontaneous pregnancy for 379 months and 74 COH + IUI cycles. Crude pregnancy rates were 45.7% in stage I/II and 40.5% in stage III/IV. Twelve-month cumulative pregnancy rates in stage I/II were 45% for spontaneous attempts and 42% for COH + IUI, and in stage III/IV were 20% for spontaneous attempts and 10% for COH + IUI (not significant). Cumulative pregnancy rates for COH/IUI in stage I/II were significantly higher than in stage III/IV. Monthly fecundity rates were 3.81% for stage I/II spontaneous, 4.59% for COH/IUI, 3.05% for stage III/IV spontaneous, and 1.68% for COH/IUI (not significant). Conclusions COH + IUI did not improve pregnancy rates in any stage of endometriosis. In stage III/IV we recommend postoperative in vitro fertilization. |
| Databáze: | OpenAIRE |
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