Abstract

To examine the impact of ethanol sclerotherapy (EST) for endometrioma on in vitro fertilization (IVF) cumulative live birth rates (CLBR) in women with moderate-severe endometriosis. This retrospective cohort study included women with moderate-severe endometriosis (revised American Fertility Society stage III-IV) and endometrioma who underwent IVF with the ultra-long agonist protocol. We compared two groups: women undergoing EST for endometrioma before IVF (EST group), and women whose endometrioma was left in situ during IVF (No-EST group). The primary outcome was the CLBR per IVF cycle, including fresh and frozen embryo transfers. The secondary endpoints included the complication rate, number of mature oocytes retrieved, clinical pregnancy rate and pregnancy loss rate. Seventy-four women were included in the study, with 37 in the EST group and 37 in the No-EST group, representing 67 and 69 IVF cycles, respectively. The population and cycle characteristics were comparable between the two groups, especially the ovarian response to stimulation. The CLBR was significantly increased in the EST group compared to the No-EST group (31.3% vs. 14.5%, p = 0.03). The clinical and biochemical pregnancy rates were significantly increased in the EST group (37.3% vs. 15.9%, p = 0.01 and 43.3% vs. 23.2%, p = 0.01, respectively). Multivariate analysis revealed a significantly increased chance of live birth in women exposed to EST before IVF with an adjusted OR of 2.68 (95% confidence interval, CI: 1.13-6.36, p = 0.02). In the EST group, we reported one major complication Clavien and Dindo classification grade III, complication involving an ovarian abscess that required a laparoscopic drainage. EST is an interesting technique to improve IVF success rates in women with moderate-severe endometriosis. EST could be discussed before IVF in infertile women.

Highlights

  • Endometriosis affects 20% to 40% of women consulting for fertility disorders [1]

  • The cumulative live birth rates (CLBR) was significantly increased in the ethanol sclerotherapy (EST) group compared to the NoEST group (31.3% vs. 14.5%, p = 0.03)

  • EST could be discussed before in vitro fertilization (IVF) in infertile women

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Summary

Introduction

Endometriosis affects 20% to 40% of women consulting for fertility disorders [1]. In particular, women with moderate-severe endometriosis (revised American Fertility Society (rAFS) stage III-IV) have lower pregnancy rates in IVF compared to infertile women with mild to moderate endometriosis (r-AFS stage I-II) or women with tubal factor [2, 3]. Roustan et al demonstrated that women with a diminished ovarian reserve after endometrioma cystectomy had significantly lower live birth rates compared with a control group with an idiopathic diminished ovarian reserve [10]. For this reason, routine excision of endometriomas before IVF is currently not recommended unless the endometrioma is painful or hampers oocyte retrieval [11, 12]. Endometriomas are associated with significantly lower ovarian response to controlled ovarian stimulation (COS) and incomplete follicular aspiration as demonstrated by reduced numbers of follicles and oocytes retrieved [13, 14]. The role of EST in the management of endometriomas is not well defined as demonstrated by the meta-analysis of Cohen et al [19]

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