menotropins and Endometriosis

This review aims to evaluate whether severe endometriosis has an impact on the outcome of in vitro fertilisation (IVF), whether IVF is associated with specific complications in this context, whether a specific ovarian stimulation protocol is most appropriate, whether the endometrial condition progresses following ovarian stimulation, and whether endometrial cysts pose a specific problem for IVF. In patients with severe endometriosis, IVF represents an effective treatment option for infertility, as a complement to surgery. The prognostic parameters of IVF are identical to those of other patients. However, the risks related to the severity of endometriosis, particularly the risk of ovarian deficiency, need to be considered. Because of this issue, to which endometriosis-related pain often adds, IVF treatment should be initiated as early as possible, using appropriate protocols and after having fully informed the patient about the specific oocytes retrieval-related risks.

Topics: Cysts; Endometriosis; Female; Fertilization in Vitro; Follicle Stimulating Hormone; Gonadotropin-Releasing Hormone; Humans; Infertility, Female; Menotropins; Ovulation Induction; Pain; Treatment Outcome; Uterine Diseases

Topics: Age Factors; Chromosome Deletion; Contraceptives, Oral, Hormonal; Endometriosis; Female; Gonadotropin-Releasing Hormone; Humans; Menotropins; Ovarian Neoplasms; Ovulation; Reproduction; Risk Factors; Talc

Due to the different pharmacological mode of action, GnRH-antagonists seem to open up new avenues to hormonal treatment in several indications. Although it may be still too early to speculate about the possible end of the era of GnRH-agonists, from what is known today, the advantages of GnRH-antagonists are most evident in our opinion. When the development of sustained delivery systems may continue and be completed, the antagonists will have a major potential within benign gynecological conditions and also in the treatment of malignancies such as prostatic, mammary, endometrial or ovarian cancer. Suitable sustained delivery systems and the development of GnRH-antagonists with sufficient oral bioavailability, represent the present and future challenge for these efforts.

Topics: Clinical Trials, Phase III as Topic; Endometriosis; Female; Follicle Stimulating Hormone; Gonadotropin-Releasing Hormone; Humans; Leiomyoma; Male; Menotropins; Neoplasms, Hormone-Dependent; Ovarian Neoplasms; Ovulation Induction; Pituitary Gland; Prostatic Neoplasms

Can controlled ovarian stimulation with low-dose human menopausal gonadotrophin (hMG) improve the clinical pregnancy rate when compared with ovarian stimulation with clomiphene citrate (CC) in an intrauterine insemination (IUI) programme for subfertile couples?. Ovarian stimulation with low-dose hMG is superior to CC in IUI cycles with respect to clinical pregnancy rate.. IUI after ovarian stimulation is an effective treatment for mild male subfertility, unexplained subfertility and minimal-mild endometriosis, but it is unclear which medication for ovarian stimulation is more effective.. A total of 330 women scheduled for IUI during 657 cycles (September 2004-December 2011) were enrolled in an open-label randomized clinical trial to ovarian stimulation with low-dose hMG subcutaneous (n = 334, 37.5-75 IU per day) or CC per oral (n = 323, 50 mg/day from Day 3-7). Assuming a difference of 10% in 'clinical pregnancy with positive fetal heart beat', we needed 219 cycles per group (alpha-error 0.05, power 0.80).. We studied subfertile couples with mild male subfertility, unexplained subfertility or minimal-mild endometriosis. Further inclusion criteria were failure to conceive for ≥12 months, female age ≤42 years, at least one patent Fallopian tube and a total motility count (TMC) ≥5.0 million spermatozoa after capacitation. The primary end-point was clinical pregnancy. Analysis was by intention to treat and controlled for the presence of multiple measures, as one couple could have more randomizations in multiple cycles. Linear mixed models were used for continuous measures. For binary outcomes we estimated the relative risk using a Poisson model with log link and using generalized estimating equations.. When compared with ovarian stimulation with CC, hMG stimulation was characterized by a higher clinical pregnancy rate (hMG 48/334 (14.4%) versus CC 29/323 (9.0%), relative risk (RR) 1.6 (95% confidence interval (CI) 1.1-2.4)), higher live birth rate (hMG 46/334 (13.8%) versus CC 28/323 (8.7%), RR 1.6 (95% CI 1.0-2.4)), low and comparable multiple live birth rate (hMG 3/46 (6.5%) versus CC 1/28 (3.6%), P > 0.99), lower number of preovulatory follicles (hMG 1.2 versus CC 1.5, P < 0.001), increased endometrial thickness (hMG 8.5 mm versus CC 7.5 mm, P < 0.001), and a lower cancellation rate per started cycle (hMG 15/322 (4.7%) versus CC 46/298 (15.4%), P < 0.001).. We randomized patients at a cycle level, and not at a strategy over multiple cycles.. This study showed better reproductive outcome after ovarian stimulation with low-dose gonadotrophins. A health economic analysis of our data is planned to test the hypothesis that ovarian stimulation with low-dose hMG combined with IUI is associated with increased cost-effectiveness when compared with ovarian stimulation with CC.. T.M.D. and K.P. were supported by the Clinical Research Foundation of UZ Leuven, Belgium. This study was also supported by the Ferring company (Copenhagen, Denmark) which provide free medication (Menopur) required for the group of patients who were randomized in the hMG COS group. The Ferring company was not involved in the study design, data analysis, writing and submission of the paper.. NCT01569945 (ClinicalTrials.gov).

Topics: Adult; Clomiphene; Endometriosis; Female; Humans; Infertility; Infertility, Female; Infertility, Male; Insemination, Artificial; Male; Menotropins; Ovulation Induction; Pregnancy; Pregnancy Rate; Sperm Motility

Ovarian stimulation combined with intra-uterine insemination (IUI) is an effective treatment of non-tubal infertility but most women undergo several cycles of treatment to achieve a pregnancy. This prospective study was designed to assess the consistency (or variation) of ovarian responses and the effect of various ovarian stimulation protocols on this consistency in consecutive cycles of ovarian stimulation and IUI in women with non-ovulatory infertility. A total of 86 regularly menstruating ovulating patients each completed three to six cycles of ovarian stimulation and IUI (n = 347 cycles). Ovarian stimulation was achieved by sequential clomiphene citrate/human menopausal gonadotrophin (HMG), HMG-only or combined gonadotrophin-releasing hormone analogue--HMG protocols in 33, 29 and 24 patients respectively, and each patient used the same protocol consistently throughout the study. Standard methods were used to monitor ovarian response and to perform IUI. Using each patient as her own control, repeated measurements analysis of variance revealed consistency of ovarian response in consecutive ovarian stimulation cycles, as shown by the number and mean diameter of maturing pre-ovulatory follicles, peak plasma oestradiol, duration of stimulation and mean HMG requirements. This consistency existed using any of the ovarian stimulation protocols. We conclude that regularly menstruating and ovulating women are likely to have similar ovarian responses in consecutive cycles of ovarian stimulation and IUI if the same ovarian stimulation protocol is used consistently.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Cervix Mucus; Chorionic Gonadotropin; Clomiphene; Endometriosis; Estradiol; Female; Gonadotropin-Releasing Hormone; Humans; Infertility; Infertility, Female; Infertility, Male; Insemination, Artificial; Luteinizing Hormone; Male; Menotropins; Ovulation Induction; Pregnancy; Prospective Studies

To determine the efficacy of superovulation with buserelin acetate, human menopausal gonadotropins (hMG), and human chorionic gonadotropin (hCG) in the treatment of infertility associated with minimal or mild endometriosis.. Prospective, randomized, controlled study.. Forty-nine infertile women with a laparoscopic diagnosis of endometriosis stage I (n = 29) or II (n = 20) according to the revised American Fertility Society classification, randomly assigned to three superovulation cycles (n = 24) or 6 months' expectant management (n = 25).. Cycle fecundity rates and cumulative pregnancy rates (CPR) in the two groups.. Nine pregnancies were obtained in the superovulation-treated patients and six in the nontreated ones. The cycle fecundity rates and CPR were 0.15% and 37.4% after three superovulation cycles and 0.045% and 24% after 6 months of expectant management (P less than 0.05 and P = not significant, respectively). The women who did not achieve a pregnancy after three cycles of superovulation were followed for a total of 50 months during which no therapy was given. One pregnancy started in this period (cycle fecundity rate = 0.020). One spontaneous abortion occurred in each group. Three treated patients had multiple pregnancies, and four had ovarian hyperstimulation syndrome.. Superovulation seems to be associated with a better cycle fecundity rate but not a better CPR than expectant management in infertile women with endometriosis stages I and II. The efficacy and side effects of this therapeutic approach should be evaluated in larger series.

Topics: Adult; Buserelin; Chorionic Gonadotropin; Endometriosis; Female; Humans; Infertility, Female; Menotropins; Prospective Studies; Superovulation

Human menopausal gonadotropin (hMG) superovulation combined with washed intrauterine insemination (IUI) has been advocated for the treatment of various forms of infertility when more traditional therapy has failed. To assess the relative efficacy of combined treatment with hMG and IUI compared with either hMG or IUI alone, pregnancy outcomes of the three treatment groups were compared in couples having infertility because of male factor, cervical factor, endometriosis, or unexplained. A total of 751 cycles were analyzed from 322 couples. The mean cycle fecundity rate associated with hMG/IUI therapy was significantly higher than either hMG or IUI therapy alone for all patients (hMG/IUI = 19.6%, hMG = 6.3%, IUI = 3.4%). The improvement in cycle fecundity rates with hMG/IUI therapy was also observed when the couples were separated by infertility diagnostic groups: male factor (hMG/IUI = 15.3%, hMG = 4.4%, IUI = 3.0%), cervical factor (hMG/IUI = 26.3%, hMG = 7.9%, IUI = 5.1%), endometriosis (hMG/IUI = 12.85%, hMG = 6.6%), and unexplained infertility (hMG/IUI = 32.6%, hMG = 5.5%, IUI = 0%). Moreover, in patients who had failed to conceive with hMG or IUI alone, the cycle fecundity rate when they were switched to hMG/IUI therapy equaled that of patients who received combined therapy from the onset. We conclude that cycle fecundity rates and cumulative pregnancy rates are significantly greater using a combination of hMG and IUI compared with either modality alone in the treatment of male factor, cervical factor, endometriosis, or unexplained infertility. Indeed, in couples with nontubal related infertility, cycle fecundity rates with hMG/IUI approach the rates seen with in vitro fertilization and gamete intrafallopian tube transfer.

Topics: Endometriosis; Female; Humans; Infertility, Female; Insemination, Artificial; Male; Menotropins; Menstrual Cycle; Pregnancy; Retrospective Studies

The relationship between fibroids and infertility remains an unsolved question, and management of intramural fibroids is controversial. During the implantation phase, uterine peristalsis is dramatically reduced, which is thought to facilitate embryo implantation. Our aims were to evaluate (i) the occurrence and frequency of uterine peristalsis in infertile women with intramural fibroids and (ii) whether the presence of uterine peristalsis decreases the pregnancy rate.. Ninety-five infertile patients with uterine fibroids were examined using magnetic resonance imaging (MRI). Inclusion criteria were as follows: (i) presence of intramural fibroids, excluding submucosal type; (ii) no other significant infertility factors (excluding endometriosis); and (iii) regular menstrual cycles, and MRI performed at the time of implantation (luteal phase day 5-9). The frequency of junctional zone movement was evaluated using cine-mode-display MRI. After MRI, patients underwent infertility treatment for up to 4 months, and the pregnancy rate was evaluated prospectively.. Fifty-one patients fulfilled the inclusion criteria, and 29 (57%) and 22 (43%) patients were assigned to the low (0 or 1 time/3 min) or high frequency (≥ 2 times/3 min) uterine peristalsis group, respectively. Endometriosis incidence was the same in both groups. Ten out of the 29 patients (34%) in the low-frequency group achieved pregnancy, compared with none of the 22 patients (0%) in the high-frequency group (P< 0.005). Comparing pregnant and non-pregnant cases, 4 of 10 patients (40%) and 9 of 41 patients (22%), respectively, had endometriosis (not significant).. A higher frequency of uterine peristalsis during the mid-luteal phase might be one of the causes of infertility associated with intramural-type fibroids.

Topics: Adult; Clomiphene; Endometriosis; Female; Fertility Agents, Female; Humans; Infertility, Female; Leiomyoma; Magnetic Resonance Imaging; Menotropins; Ovulation Induction; Peristalsis; Pregnancy; Pregnancy Complications, Neoplastic; Pregnancy Rate; Prospective Studies; Retrospective Studies; Uterine Neoplasms

To investigate the outcome of in vitro fertilization and embryo transfer (IVF-ET) in special infertile patients following modified super-long down-regulation protocol combined with human menopausal gonadotropin (HMG) stimulation.. Ninety-nine special patients (42 with endometriosis, 35 with PCOS, and 22 with insufficient down-regulation) who underwent modified super-long down-regulation protocol in 2008 were retrospectively analyzed. Gonadotropin releasing hormone analogues (GnRHa, 1.5 mg) was injected intramuscularly in mid-luteal phase twice and HMG was started 25 days later after the second GnRHa injection. Conventional IVF-ET was performed as routine procedure. The clinical outcomes were compared with those of 122 similar patients in the same period.. After modified super-long down-regulation, (1) in endometriosis patients, the average gonadotropin (Gn) used was (32.33 +/- 15.11) ampoules, duration of medication was (10.57 +/- 1.88) days, the progesterone (P) level on hCG day was (0.78 +/- 0.44) microg/L, and the clinical pregnancy rate (CPR) was 73.8%; (2) in PCOS patients, the average Gn used was (28.57 +/- 12.07) ampoules, the duration of medication was (11.71 +/- 2.07) days, the P level at hCG day was (0.65 +/- 0.39) microg/L, and the clinical pregnancy rate was 65.7%; (3) in insufficient down-regulation patients, the average Gn used was (26.22 +/- 12.07) ampoules, the duration of medication was (10.01 +/- 1.77) days, the P level at hCG day was (0.71 +/- 0.50) microg/L, and the clinical pregnancy rate was 72.7%. Compared with patients using regular down-regulation protocol, the clinical pregnancy rate was improved significantly and the cost decreased obviously. The clinical pregnancy rate significantly improved compared with that of routine long down-regulation groups.. Revised super-long protocol plus HMG is a cost-effective controlled ovary hyperstimulation (COH) regimen for infertile patients with endometriosis, PCOS and insufficient down-regulation.

Topics: Adult; Embryo Transfer; Endometriosis; Female; Fertility Agents, Female; Fertilization in Vitro; Gonadotropin-Releasing Hormone; Humans; Infertility, Female; Menotropins; Ovulation Induction; Polycystic Ovary Syndrome; Pregnancy; Retrospective Studies; Treatment Outcome

Endometriosis befalls in one of the most frequent gynecologic diseases. It manifests itself by the presence and growth of focus of endometrium out of the uterus cavum that reacts to hormonal stimulations as the normal uterus endometrium does. Hyperstimulation and induction of ovulation together with intrauterine insemination (IUI) are the most frequently used treatments of unexplained infertility in patients with mild type endometriosis. The aim of this study was to compare the effects of stimulation using human meno pausal gonadotrophine (hMG) in the patients with mild type endometriosis to the patients with infertility of unknown ethiology.. The study included 50 patients with unexplained infertility (group N), as well as 50 patients with mild type endometriosis (group E) confirmed by laparoscopy. Within the same therapeutic protocole hIMG stimulation and horionic gonadotrophine induction (hCG) were used.. In the group E ovulation occurred in 74% of the pa tients during the first stimulation, in 77.78% during the second cycle, and in 75% of the patients during the third one. Regarding the group N, ovulation appeared in 82% of the patients during the first stimulation. Stimulation was performed two times more in 38 patients with unknown couse of infertil ity, and ovulation appeared in 84.21 percent of them. In the group N stimulation was performed three times in 28 women resulting in ovulation in 85.71% of them.. Con sidering the obtained results it can be concluded that hMG stimulation and hCG induction are efficient in the treatment of infertility, particularly in mild type endometriosis.

Topics: Adult; Chorionic Gonadotropin; Endometriosis; Female; Humans; Infertility, Female; Menotropins; Ovulation Induction; Pregnancy

Topics: Adenocarcinoma, Clear Cell; Adult; Clomiphene; Endometriosis; Female; Fertility Agents, Female; Humans; Hysterectomy; Infertility, Female; Menotropins; Neoplasm Staging; Ovarian Diseases; Ovarian Neoplasms; Ovariectomy; Ovulation Induction; Treatment Outcome

To evaluate how endometriosis affects expression of vascular endothelial growth factor (VEGF) and interleukin-6 (IL-6) in granulosa cells.. Prospective study.. IVF-ET program at Osaka Medical College.. Seventeen patients with revised American Fertility Society stage IV endometriosis and 17 patients with tubal infertility and no endometriosis.. Granulosa cells obtained at oocyte retrieval were examined for VEGF and IL-6 gene expression.. Serum E(2) and P levels at hCG administration, number of oocytes, fertilization rate, high-quality embryo rate, and pregnancy rate, and expression of VEGF and IL-6 genes.. Total hMG and FSH levels were statistically significantly higher in patients with endometriosis; however, the number of retrieved oocytes and the fertilization rate were lower compared with patients with tubal infertility. Serum E(2) levels and expression of VEGF in patients with tubal infertility were statistically significantly higher than those in patients with endometriosis. Interleukin-6 gene expression did not differ between the groups.. In severe endometriosis, lower VEGF gene expression in granulosa cells may adversely affect oocyte development and maturation.

Topics: Chorionic Gonadotropin; Embryo Transfer; Endometriosis; Endothelial Growth Factors; Estradiol; Fallopian Tube Diseases; Female; Fertilization in Vitro; Follicle Stimulating Hormone; Gene Expression; Granulosa Cells; Humans; Infertility, Female; Intercellular Signaling Peptides and Proteins; Interleukin-6; Lymphokines; Menotropins; Oocytes; Ovulation Induction; Polymerase Chain Reaction; Pregnancy; Progesterone; Prospective Studies; Reproductive Techniques, Assisted; Vascular Endothelial Growth Factor A; Vascular Endothelial Growth Factors

In-vitro fertilization (IVF) is an effective infertility treatment for women with endometriosis, but most women need to undergo several cycles of treatment to become pregnant. This case-control study was designed to assess how consistently women with ovarian endometriosis respond to ovarian stimulation in consecutive treatment cycles compared to women with tubal infertility. We compared outcome measures in 40 women with a history of surgically confirmed ovarian endometriosis and 80 women with tubal infertility, all of whom had at least three IVF treatment cycles. The groups were matched for age and early follicular follicle stimulating hormone (FSH) concentration at their first IVF cycle. Outcome measures included number of follicles, number of oocytes, peak oestradiol concentration and number of FSH ampoules required per follicle. Cumulative pregnancy and live birth rates were calculated in both groups. The ovarian endometriosis group had a significantly poorer ovarian response and required significantly more ampoules of FSH per cycle, a difference that became greater with each subsequent cycle. However, cumulative pregnancy (63.3 versus 62.6% by fifth cycle) and live birth (46.8 versus 50.9% by fifth cycle) rates were similar in both groups. In conclusion, despite decreased ovarian response to FSH, ovarian endometriosis does not decrease the chances of successful IVF treatment.

Topics: Adult; Case-Control Studies; Cell Count; Chorionic Gonadotropin; Embryo Transfer; Endometriosis; Estradiol; Fallopian Tube Diseases; Female; Fertilization in Vitro; Follicle Stimulating Hormone; Humans; Infertility, Female; Menotropins; Nafarelin; Oocytes; Ovarian Diseases; Ovarian Follicle; Ovulation Induction; Pregnancy; Prospective Studies

In-vitro fertilization (IVF) and ovarian stimulation are frequently performed in patients with endometriosis. Although endometriosis is a hormone-dependent disease, the rate of IVF complications related to endometriosis is low. We report four cases of severe digestive complications due to the rapid growth of sigmoid endometriosis under ovarian stimulation. In three patients, sigmoid endometriosis was diagnosed at laparoscopy for sterility. Because of the absence of digestive symptoms or repercussion on the bowel, no bowel resection was performed before ovarian stimulation. All patients experienced severe digestive symptoms during ovarian stimulation, and a segmental sigmoid resection had to be performed. Analysis of endoscopic and radiological data demonstrated that bowel lesions of small size may rapidly enlarge and become highly symptomatic under ovarian stimulation. At immunohistochemistry, these infiltrating lesions displayed high populations of steroid receptors and a high proliferative index (Ki-67 activity), suggesting a strong dependence on circulating ovarian hormones and a potential for rapid growth under supraphysiological oestrogen concentrations. Clinicians should be aware of this rare but severe digestive complication of ovarian stimulation. The early diagnosis of such lesions may help the patients to avoid months of morbidity falsely attributed to ovarian stimulation side effects. Further experience is necessary to determine the optimal attitude when diagnosing a small and asymptomatic endometriotic bowel lesion before ovarian stimulation.

Topics: Adult; Buserelin; Chorionic Gonadotropin; Digestive System Diseases; Endometriosis; Female; Fertilization in Vitro; Humans; Immunohistochemistry; Infertility, Female; Ki-67 Antigen; Menotropins; Ovulation Induction; Receptors, Steroid; Sigmoid Diseases

To estimate the clinical effectiveness of in vitro fertilization treatment in patients with minimal or mild endometriosis (stages I and II) in comparison to the patients with tubal infertility in terms of fertilization, pregnancy and livebirth rates.. Retrospective analysis of the outcome of IVF-ET in 612 cycles of the patients with endometriosis (389 stimulated with HMG/HCG and 223 co-treated with GnRH-a) and in 7,339 cycles of the patients with tubal infertility (5,520 stimulated with HMG/HCG and 1,819 co-treated with GnRH-a). RESULLTS: Regardless of the type of ovarian stimulation, the fertilization rate per treated cycle was practically the same in both groups (endometriosis 81.4% vs tubal infertility 84.2%; p = 0.07). However, in the endometriosis group the pregnancy rate was higher (25.3% vs 18.9%; p = 0.000), and so was the livebirth rate (19.0% vs 14.2%; p = 0.003). Considering the type of ovarian stimulation, the fertilization rate in the endometriosis group was almost the same in the HMG/HCG (81.2%) and in the GnRH-a co-treated cycles (81.6%), and did not differ from that in the tubal infertility group (83.6% in the HMG/HCG vs 85.9% in the GnRH-a cycles). In the GnRH-a co-treated cycles the pregnancy rate and the livebirth rate were not significantly higher in the endometriosis group than in the tubal infertility group (27% and 20.2% vs 22.2% and 17.5%). In the HMG/HCG stimulated cycles the pregnancy rate was significantly higher in the endometriosis than in the tubal infertility group (24.3% vs 17.7%; p = 0.004), and so was the livebirth rate (18.4% vs 13.0%; p = 0.008).. In patients with minimal or mild endometriosis the IVF-ET procedure is at least as effective as in patients with tubal infertility.

Topics: Adult; Chorionic Gonadotropin; Embryo Transfer; Endometriosis; Estradiol; Fallopian Tube Diseases; Female; Fertilization in Vitro; Humans; Infertility, Female; Menotropins; Ovulation Induction; Pregnancy; Pregnancy Outcome; Retrospective Studies

To determine whether age, diagnosis, and cycle number influence cycle fecundity associated with gonadotropin-induced controlled ovarian hyperstimulation/IUI.. Retrospective analysis.. The Center for Reproductive Medicine at the Brigham and Women's Hospital, a tertiary care academic medical center.. Two hundred seventy-four women who underwent controlled ovarian hyperstimulation with gonadotropins and IUI.. Infertility treatment with gonadotropins and IUI.. Pregnancy rates according to patient age, infertility diagnosis, and number of treatment cycles.. Pregnancy rates decreased with increasing patient age. The cumulative pregnancy rates varied greatly by diagnosis from 13% for patients with male factor infertility to 84% for patients with ovulatory factor infertility. Average cycle fecundity was considerably less varied by diagnosis. All pregnancies among patients with male factor infertility and tubal factor infertility were achieved during the first two cycles.. There is a clear age-related decline in fecundity associated with gonadotropin-induced controlled ovarian hyperstimulation/IUI. Patients <40 years of age and those with male factor infertility or tubal factor infertility have a particularly poor prognosis.

Topics: Adult; Aging; Anovulation; Endometriosis; Fallopian Tube Diseases; Female; Follicle Stimulating Hormone; Humans; Infertility; Infertility, Male; Insemination, Artificial, Homologous; Male; Menotropins; Middle Aged; Ovulation Induction; Pregnancy; Retrospective Studies

The impact of severity of endometriosis on the outcome of in vitro fertilization (IVF) was analyzed in an uncontrolled, retrospective study in an academic IVF program.. Sixty-one patients with a primary diagnosis of endometriosis undergoing 85 cycles of IVF were included in the study. Patients were divided according to the severity of disease based on the revised American Fertility Society (AFS) classification into groups A (stages I/II, or minimal/ mild) and B (stages III/IV, or moderate/severe). Group A included 32 patients undergoing 45 IVF-embryo transfer (ET) cycles; group B included 29 patients undergoing 40 IVF cycles. Exclusion criteria were age older than 40 years, basal day 3 follicle stimulating hormone (FSH) greater than 20 IU/L, male-factor infertility, assisted hatching, and gamete intrafallopian transfer cases. Stimulation for IVF cycles was standard using pituitary down-regulation with gonadotropin-releasing hormone agonist in a midluteal protocol. Controlled ovarian hyperstimulation (COH) was achieved using a combination of FSH and human menopausal gonadotropin. Outcomes assessed included response to COH and number, maturity, and quality of oocytes retrieved. Fertilization, implantation, and pregnancy rates after IVF-ET were also analyzed.. The response to COH and the number, maturity, and quality of the oocytes was comparable between patients with varying severity of endometriosis. Fertilization rates for oocytes of patients in group B (stages III/IV) were significantly impaired compared to those in group A (stages I/II) (P = 0.004). The rates for implantation, clinical pregnancy, and miscarriage were comparable between the two groups.. The reduced fertilization potential of the oocytes obtained from patients with severe endometriosis in the absence of male-factor infertility suggests an adverse biological impact of the advanced disease on the oocytes. The outcome of IVF-ET, however, is unaffected by increasing severity of endometriosis. This suggests that IVF may compensate for or overcome this reduction in the biological potential of the oocytes associated with severe disease, thus accounting for a comparable outcome irrespective of the severity of endometriosis.

Topics: Adult; Embryo Implantation; Embryo Transfer; Endometriosis; Female; Fertilization in Vitro; Follicle Stimulating Hormone; Humans; Infertility; Menotropins; Oocytes; Outcome Assessment, Health Care; Ovarian Hyperstimulation Syndrome; Pregnancy; Retrospective Studies

To determine Müllerian inhibiting substance (MIS) levels in follicular fluid (FF) and sera of IVF patients.. Prospective study.. Fertility center.. Sixty-six patients: 20 with tubal factor infertility, 17 with polycystic ovary syndrome (PCOS), and 29 with endometriosis.. All patients underwent ovarian stimulation with hMG and/or FSH, as well as oocyte retrieval for IVF.. Follicular fluid and serum MIS levels and oocyte fertilization rates.. Levels of MIS in FF and sera of PCOS patients were significantly higher than those in tubal factor patients: 7.01 +/- 1.52 versus 1.65 +/- 0.23 ng/mL (mean +/- SE) and 2.97 +/- 0.52 versus 0.92 +/- 0.19 ng/mL, respectively. In endometriosis patients, follicular fluid and serum MIS levels were not significantly different from those in tubal factor patients. In PCOS patients, the percentage of immature oocytes retrieved (17.9% +/- 5.0%) was significantly higher compared with tubal factor (1.5% +/- 1.0%) and endometriosis (9.2% +/- 2.3%) patients. The percentage of oocytes fertilize was significantly lower in PCOS patients (30.2% +/- 5.3%) compared with tubal factor (62.2% +/- 5.5%) and endometriosis (37.5% +/- 5.7%) patients.. Women with PCOS had higher serum and follicular fluid MIS levels, a higher percentage of immature oocytes, and lower fertilization rates than women with endometriosis or pelvic adhesions.

Topics: Adult; Anti-Mullerian Hormone; Endometriosis; Fallopian Tube Diseases; Female; Fertilization in Vitro; Follicle Stimulating Hormone; Follicular Fluid; Glycoproteins; Growth Inhibitors; Humans; Infertility, Female; Menotropins; Ovulation Induction; Polycystic Ovary Syndrome; Prospective Studies; Testicular Hormones

To compare the outcome of in vitro fertilization and embryo transfer (IVF-ET) after laparoscopic surgery in women with endometriosis with that of patients with tubal factor infertility.. Retrospective survey of hospital and office charts using a computerized worksheet.. Lin-Kou medical center of Chang Gung Memorial Hospital.. Sixty-seven women with minimal to mild or moderate to severe endometriosis. Women with tubal factor infertility without other associated disorders (60 cycles) made up the control group.. Seventy-five consecutive cycles of IVF-ET were performed in these patients who failed to conceive after laparoscopic conservative surgery.. The concentration of serum estradiol on the day of human chorionic gonadotropin (hCG) injection, the day of hCG injection, clinical pregnancy rates per transfer, number of follicles larger than 14 mm, number of embryos transferred, and implantation rate were not significantly different between women with endometriosis and those with tubal factor infertility. The number of oocytes retrieved and number fertilized were decreased, and the basal level of follicle-stimulating hormone on cycle day 3 was higher in women with both degrees of endometriosis. Women in both endometriosis groups received more follicle-stimulating hormone and human menopausal gonadotropin than those with tubal factor infertility.. The outcome of IVF-ET in patients with endometriosis after laparoscopic surgery did not differ from that in the group with tubal factor infertility, but the former required more ampules of gonadotropin to achieve the same response. The advantages of laparoscopic surgery in women with endometriosis should be probably correlated with success of IVF-ET.

Topics: Adult; Case-Control Studies; Chorionic Gonadotropin; Danazol; Embryo Transfer; Endometriosis; Estrogen Antagonists; Female; Fertilization in Vitro; Follicle Stimulating Hormone; Humans; Infertility, Female; Laparoscopy; Leuprolide; Menotropins; Pregnancy; Retrospective Studies; Treatment Outcome

To investigate the impact of endometriosis stage on IVF.. A retrospective study of 214 patients diagnosed with endometriosis who underwent 360 cycles of IVF at The New York Hospital-Cornell Medical Center. Meanwhile, 111 pure mechanical (tubal) infertility patients treated in 160 cycles at the same time were designated as the control group for comparison.. Patient's hormone and semen profiles, hormonal response and outcome to stimulation, as well as the outcome of pregnancy, abortion, and delivery rate were analyzed.. No differences in the pregnancy outcome between the endometriosis and control groups were noted when compared among the subgroups of pure endometriosis, endometriosis plus tubal factor, endometriosis plus others (primarily endometriosis plus male factor), and control. Comparing the outcomes in pure endometriosis cases by staging, we could not find any discrepancies in terms of pregnancy rates (PRs) according to the severity of the disease. The addition of GnRH analogur down-regulation to gonadotropin stimulation resulted in an increase in PR. A relatively high delivery rate (38.9% per cycle, 41.9% per retrieval, and 43.2% per transfer) was achieved when the pure endometriosis patients were treated with concomitant leuprolide acetate down-regulation and gonadotropin.. We have observed that pregnancy outcome in patients with endometriosis was not different than the outcome for patients with mechanical (tubal) infertility. There were no differences in PRs by stage of endometriosis.

Topics: Adult; Endometriosis; Female; Fertilization in Vitro; Follicle Stimulating Hormone; Humans; Leuprolide; Menotropins; Pregnancy; Pregnancy Outcome; Retrospective Studies

The objective of our study was to establish the most adequate ovarian stimulation regimen for assisted procreation in endometriotic patients. It consisted of a retrospective analysis comparing the use of the gonadotrophin-releasing hormone analogue (GnRHa) buserelin either for 3 months or for 3 weeks and continued with ovarian stimulation with human menopausal gonadotrophin (HMG), and the use of clomiphene citrate in association with HMG for in-vitro fertilization (IVF) and embryo transfer, gamete intra-Fallopian transfer (GIFT) and zygote intra-Fallopian transfer (ZIFT). A total of 145 patients with endometriosis in 174 cycles were divided into two groups according to the revised American Fertility Society staging of the disease (group A, stages 1 and 2; group B, stages 3 and 4). The use of GnRHa significantly increased the number of oocytes retrieved. GnRH analogues for 3 months gave the highest fertilization rate for groups A and B. The cleavage, pregnancy and delivery rates, although higher in the groups treated with analogues, did not reach statistical significance. A higher number of patients had an embryo transfer in the groups treated with GnRHa (P < 0.05). Treatment with GnRHa for either 3 months or for 3 weeks proved to be more efficient than clomiphene citrate-HMG for assisted procreation procedures in patients with endometriosis.

Topics: Adult; Buserelin; Cleavage Stage, Ovum; Clomiphene; Cryopreservation; Embryo Implantation; Endometriosis; Female; Fertilization in Vitro; Gamete Intrafallopian Transfer; Humans; Infertility, Female; Menotropins; Ovulation Induction; Pregnancy; Pregnancy, Ectopic; Pregnancy, Multiple; Retrospective Studies; Zygote Intrafallopian Transfer

Exogenous estradiol (E2) has a well-recognized interceptive action when administered shortly after ovulation. The influence of extremely elevated levels of endogenous E2 on human oocyte fertilization and implantation are unclear. The purpose of this study was to evaluate a potential antinidatory role of extremely high endogenous E2 concentrations on implantation and pregnancy during in vitro fertilization-embryo transfer (IVF-ET).. Twenty-five patients receiving human menopausal gonadotropins (hMG) following midluteal GnRHa administration for IVF-ET, in which the maximal E2 concentration was > 5000 pg/ml (range 5358-16,344 pg/ml) were studied. Cycle parameters including oocyte and embryo characteristics, fertilization, cleavage, and implantation rates as well as pregnancy outcomes were compared to those of 25 patients treated contemporaneously whose treatment cycles had peak E2 values < 3500 pg/ml. Patients groups were matched for age, infertility diagnoses, duration of infertility and stimulation protocol.. Cycles characterized by very high endogenous E2 levels resulted in significantly more oocytes per retrieval (21.4 +/- 1.7 versus 8.4 +/- 0.6; P < 0.0001), fewer postmature oocytes (1.6% +/- 1.0% versus 14% +/- 5.0%; P < 0.03), and a decreased fertilization rate (63% +/- 4.0% versus 73% +/- 3.0%; P < 0.04) compared to control cycles. There were no differences in the overall mean morphologic grade or cleavage rates between groups. However, high E2 cycles were associated with a significantly increased implantation rate (14% +/- 4.0% versus 8.0% +/- 4.0%; P < 0.01) and pregnancy rate per embryo transfer (62% +/- 16% versus 36% +/- 16%; P < 0.01) compared to controls. The incidence of spontaneous abortion did not differ between groups. CONCLUSIONS; Extremely high endogenous E2 levels do not appear to adversely affect implantation or overall cycle pregnancy rates in IVF-ET cycles. However, impaired fertilization rates in such cycles support a potential adverse effect on oocyte quality.

Topics: Adult; Embryo Implantation; Embryo Transfer; Endometriosis; Estradiol; Female; Fertility Agents, Female; Fertilization in Vitro; Humans; Infertility, Female; Menotropins; Ovarian Hyperstimulation Syndrome; Ovulation Induction; Pregnancy; Radioimmunoassay

The purpose of this study was to determine the effects of pituitary down-regulation for several months on the outcome of in vitro fertilization treatment in women with severe endometriosis.. A total of 84 patients with severe endometriosis (grades III and IV) were recruited in a semirandomized prospective study; 69 of these were controls who were given a short protocol with gonadotropin-releasing hormone agonist followed by human menopausal gonadotropin and human chorionic gonadotropin to induce follicular growth. Fifteen treated patients underwent down-regulation for 2 to 7 months and then human menopausal gonadotropin and human chorionic gonadotropin to induce follicular growth. Twenty nonpregnant controls after in vitro fertilization were treated in a similar manner.. The pregnancy rates were much high per embryo transfer, 18 of 42 (42.8%), especially in patients in whom in vitro fertilization was carried out during the fourth month of down-regulation. Pregnancy rates in the control group were 17 of 134 (12.7%) (p < 0.001).. Higher rates of pregnancy are achieved after in vitro fertilization that follows long-term down-regulation in women with extensive endometriosis.

Topics: Adult; Analysis of Variance; Chorionic Gonadotropin; Down-Regulation; Endometriosis; Female; Fertilization in Vitro; Gonadotropin-Releasing Hormone; Humans; Menotropins; Pituitary Gland; Pregnancy; Pregnancy Outcome; Prospective Studies; Regression Analysis; Time Factors

To investigate the effects of leuprolide acetate (LA), a GnRH agonist (GnRH-a), and of danazol on the hypothalamic-pituitary-ovarian axis in patients with endometriosis.. Ten patients were divided into LA and danazol treatment groups.. Serum levels of E2, immunoreactive and bioactive LH, pulsatility of LH, and gonadotropins release by GnRH. Changes in serum E2 levels by hMG administration during LA treatment.. Serum E2 level decreased to near castrated levels during the LA treatment, while it remained unchanged during the danazol treatment. Leuprolide acetate administration resulted in a significant suppression of the serum level of bioactive LH, of the pulsatility of LH release, of the pituitary response to GnRH injection, and of the elevation in the serum E2 level by hMG administration, but danazol treatment did not show these suppressive effects.. Our results suggest that the hormonal actions of LA and danazol on endometriosis are different from each other, especially in the suppression of serum E2 level.

Topics: Adult; Danazol; Endometriosis; Estradiol; Female; Follicle Stimulating Hormone; Gonadotropin-Releasing Hormone; Humans; Hypothalamo-Hypophyseal System; Leuprolide; Luteinizing Hormone; Menotropins; Ovary; Pulsatile Flow

A woman with longstanding primary infertility and progressive, symptomatic rectal endometriosis was treated with daily leuprolide acetate for nine months. All bowel symptoms subsided. The patient was treated with human menopausal gonadotropin and intrauterine insemination prior to discontinuation of the leuprolide acetate, resulting in a twin pregnancy.

Topics: Adult; Chorionic Gonadotropin; Drug Therapy, Combination; Endometriosis; Female; Humans; Infertility, Female; Insemination, Artificial, Heterologous; Leuprolide; Menotropins; Pregnancy; Rectal Diseases

Two protocols were scheduled for in vitro fertilization and embryo transfer (IVF-ET) in patients with various stages of endometriosis who were resistant to conventional therapies. In the ultralong protocol (21 patients), gonadotropin releasing hormone agonist (Gn-RHa) was administered for at least 60 days prior to ovarian stimulation along with menotropin until human chorionic gonadotropin was injected. In the long protocol (11 patients), Gn-RHa was started at the midluteal phase and exogenous gonadotropin was commenced between the third and the seventh day of the menstrual cycle after pituitary suppression. The estradiol response and the number of retrieved oocytes, fertilized oocytes, cleaved oocytes, and transferred embryos were similar in both groups but the clinical pregnancy rate per transfer was superior in the ultralong protocol (67 vs 27%). The miscarriage rate was 14% (2/14) in the ultralong protocol. Prolonged Gn-RHa suppression of ovarian function before superovulation may overcome some causes of infertility in patients with endometriosis.

Topics: Adult; Antigens, Tumor-Associated, Carbohydrate; Buserelin; Endometriosis; Female; Fertilization in Vitro; Humans; Infertility, Female; Menotropins; Ovulation Induction; Pregnancy; Treatment Outcome

The difficulty in evaluating the efficacy of treatments for endometriosis in terms of sterility results from the frequent confusion between the inhibition of the natural progression of endometriosis and a beneficial effect on fertility. The authors review the supposed benefits and the drawbacks of the various medical and surgical treatments available and medically assisted fertilization (IVF) in the context of the various types of endometriosis damage. They highlight the inadequacy of the AFS score, which gives very similar scores for effects with widely differing impacts on fertility. The authors attempt to identify the therapeutic associations which seem currently to be useful in treating endometriosis and also beneficial in obtaining a pregnancy.

Topics: Adult; Clomiphene; Danazol; Endometriosis; Female; Fertilization in Vitro; Gestrinone; Gonadotropin-Releasing Hormone; Humans; Infant, Newborn; Infertility, Female; Medroxyprogesterone; Menotropins; Pregnancy; Randomized Controlled Trials as Topic

The results of IVF in cases of tubal sterility are compared with those of surgery (macro- or micro-surgery, coelio-surgery). This analysis includes a continuous series of 1051 attempted pregnancies in 640 women (with or mixed tubal sterility with or without endometriosis). After an average 1.64 attempts per patient, 220 women had achieved 241 pregnancies (pregnancy rate: 22.9% per puncture, 34.3% per woman). Of these 241 pregnancies, there were 172 (71.8%) which continued to term, 57 (23.6%) miscarriages and 11 (4.6%) ectopic pregnancies. The pregnancies carried to term were single pregnancies in 129 cases (74.6%), twin pregnancies in 37 cases (21.4%) and triple pregnancies in 7 cases (4%). The indication of coelio-surgery (or microsurgery) is justified in young women with no history of genital tuberculosis, tubal plasty or ectopic pregnancy and presenting with purely tubal sterility with a good prognosis. Restoration of patency after tubal sterilization remains a good indication for microsurgery in young women. In all other cases, indication is for IVF from the outset.

Topics: Adult; Clomiphene; Endometriosis; Fallopian Tube Diseases; Female; Fertilization in Vitro; Humans; Infant, Newborn; Infertility, Female; Insemination, Artificial; Menotropins; Ovulation Induction; Pregnancy; Pregnancy, Ectopic; Pregnancy, Multiple; Prognosis; Retrospective Studies; Triplets

Thirty-five women who had been operated on for mild or moderate endometriosis were evaluated through 40 menstrual cycles by daily measurements of salivary progesterone concentrations. As controls, 17 women with normal ovulatory cycles and no endometriosis were studied. In the endometriosis group, 22 cycles were unstimulated, seven were stimulated by clomiphene citrate and 11 with clomiphene citrate, human menopausal gonadotrophin and human chorionic gonadotrophin. A variety of aberrations in profiles of salivary progesterone secretion was detected in all the groups of endometriosis patients and the frequency of normal cycles was significantly lower than in controls (14-18% versus 82%, P less than 0.01). The response to the treatments varied greatly within the groups. In conclusion, the present data demonstrate that patients with endometriosis have a variety of defects in the menstrual pattern of salivary progesterone secretion and that their corpus luteum function responds poorly to stimulatory treatments.

Topics: Adult; Chorionic Gonadotropin; Clomiphene; Corpus Luteum; Endometriosis; Female; Humans; Luteal Phase; Menotropins; Ovulation Induction; Progesterone; Salivary Glands

We conclude that the acutely preovulatory expression of CA-125 in serum and FF as determined by EIA is low and not significantly enhanced by OH. Although the PF concentrations were elevated in women with minimal endometriosis when compared with women without endometriosis, the still unresolved problem associated with measurements of CA-125 in PF for both RIA and EIA and the considerable overlap in individual values between both patient groups preclude its use as a reliable screening or monitoring parameter, at least for the present.

Topics: Antigens, Tumor-Associated, Carbohydrate; Chorionic Gonadotropin; Endometriosis; Estradiol; Female; Fertilization in Vitro; Follicle Stimulating Hormone; Humans; Immunoenzyme Techniques; Menotropins; Ovarian Follicle; Ovary; Peritoneal Cavity; Retrospective Studies

This study was designed to compare the clinical and hormonal efficacy of the treatment for endometriosis using continuous infusion of three different doses of GnRH agonist (A). In addition, we examined the ovarian responsiveness to human menopausal gonadotropin (hMG) administration during GnRH-A treatment. Thirteen endometriosis patients were divided into 3 groups and given different doses. GnRH-A (Buserelin) was infused continuously through the subcutaneous route at rates of 200 micrograms (Group I; n = 5), 100 micrograms (Group II, n = 4) and 10 micrograms (Group III; n = 4) per day for 24 weeks. After the start of treatment, serum estradiol (E2) was suppressed to the menopausal range within 2 weeks and thereafter maintained this range until 24 weeks in each group. The LH and FSH response to a GnRH Challenge test was completely abolished within 2 weeks in 3 groups. Although serum FSH decreased to below the pretreatment value within a week, the FSH level was significantly lower in groups I and II than in group III until 8 weeks. No difference in the LH level during the treatment was seen among the 3 groups. After completion of the 24 weeks' treatment, FSH increased rapidly, and ovulation returned within 4 to 6 weeks in each group. Pregnancy was achieved in two patients in group I, one patient in group II and one patient in group III during cycles 2 and 5. Serum E2 increased to 200-300 pg/ml in 3 out of 7 patients treated with hMG during GnRH-A infusion, whereas no increase in E2 was seen in the remaining 4 patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Buserelin; Drug Interactions; Endometriosis; Estradiol; Female; Follicle Stimulating Hormone; Humans; Infusions, Parenteral; Luteinizing Hormone; Menotropins; Ovary; Ovulation

To determine the effect of ovarian endometriomas on in vitro fertilization (IVF) outcome, two groups of patients were studied. Group I consisted of seven patients with ovarian endometriomas and severe pelvic adhesions treated for a total of 12 cycles. Group II patients consisted of eight patients with hydrosalpinges and comparable pelvic adhesions treated for a total of 27 cycles. There were no differences in the number of days required for stimulation or in the serum estradiol levels attained between the two groups. Group I patients were noted to have significantly fewer preovulatory follicles (1.42 vs 3.33, P less than 0.005), cycles with fertilization (28 vs 84%, P less than 0.005), and embryos transferred (0.78 vs 2.56, P = 0.01) than Group II patients. Three pregnancies occurred in Group II, while there were no conceptions among Group I patients. This study suggests that the presence of an ovarian endometrioma(s) has an adverse effect on IVF outcome and suggests that patients with ovarian endometriomas should have them removed prior to undergoing IVF.

Topics: Adult; Embryo Transfer; Endometriosis; Estradiol; Female; Fertilization; Fertilization in Vitro; Humans; Luteinizing Hormone; Menotropins; Ovarian Neoplasms; Ovulation; Pelvic Inflammatory Disease; Pregnancy; Pregnancy Outcome

In vitro fertilization and embryo transfer (IVF-ET) and gamete intrafallopian transfer (GIFT) are used to treat intractable infertility in women with no distortion of the pelvic viscera, despite the lack of controlled trials demonstrating efficacy. The mechanism of any purportedly enhanced cycle fecundity in ovulatory women without significant distortion of the pelvic viscera is unclear, but both GIFT and IVF-ET increase the number of male and female gametes at the site of fertilization. Intrauterine insemination (IUI) during human menopausal gonadotropin (hMG)-stimulated superovulatory cycles has similar potential but does not require oocyte retrieval. To evaluate the possibility that simply increasing the number of gametes at the site of fertilization might account for pregnancies attributed to IVF-ET and GIFT, the authors retrospectively analyzed the outcome of couples undergoing IUI during hMG cycles between 1983 and 1986 in women with normal pelvic anatomy. IUI during hMG-stimulated cycles yielded a cycle fecundity (f) of 0.17 for endometriosis, 0.29 for cervical factor, and 0.19 for idiopathic infertility, which approaches the fecundity of normal women and equals or exceeds that reported for IVF-ET and GIFT. The authors conclude that treatment with IUI in hMG cycles, alleviating the need for invasive oocyte retrieval, should be considered for inclusion in a randomized, controlled trial in comparison with IVF-ET and GIFT.

Topics: Cervix Mucus; Embryo Transfer; Endometriosis; Female; Fertilization in Vitro; Humans; Infertility, Female; Insemination, Artificial; Insemination, Artificial, Homologous; Male; Menotropins; Oocytes; Ovulation; Pelvic Inflammatory Disease; Sperm Transport; Superovulation

In vitro fertilization and embryo transfer (IVF-ET) was performed on women with tubal disease only (28 women, 40 cycles), endometriosis grade I (15 women, 24 cycles), grade II (25 women, 37 cycles), grade III (26 women, 36 cycles), or grade IV (31 women, 52 cycles). Rates of oocyte recovery and fertilization were not affected by the presence of endometriosis. Pregnancy rates per cycle were similar to that of the tubal group (18%) for women with grade I (13%) or grade II (14%) endometriosis, lower in women with grade III endometriosis (6%) and significantly reduced in women with grade IV (2%, P less than 0.05).

Topics: Clomiphene; Endometriosis; Female; Fertilization in Vitro; Humans; Infertility, Female; Menotropins; Ovulation Induction; Pregnancy

The effectiveness of ovulation induction with clomiphene citrate or human menopausal gonadotropins was evaluated in 52 infertile women with stage I or stage II endometriosis and ovulatory dysfunction: anovulation or luteinized unruptured follicle (LUF) syndrome before (group I) and after (group II) danazol treatment. The incidence of anovulation and LUF in the endometriosis population was 9% and 34%, respectively. In group I, 10 of 36 patients (27.8%) conceived, with an average of 17.6 induction cycles per pregnancy. In group II, 21 of 30 patients (70%) conceived, with an average of 4.5 cycles per pregnancy (difference significant at P less than 0.001). There was no difference in the average number of ovulation induction cycles per patient between groups I and II (4.9 and 3.1, respectively). Of 14 patients who did not conceive in group I and crossed over to group II, 9 (64.3%) conceived (not different from group II). Spontaneous abortion rates were 20% in group I and 14% in group II. These results indicate that mild endometriosis may interfere with conception through mechanisms other than ovulatory dysfunction and that treatment with danazol appears to more than double the fertility rate.

Topics: Adult; Anovulation; Clomiphene; Danazol; Endometriosis; Female; Humans; Menotropins; Ovarian Diseases; Ovulation Induction; Pregnadienes

Thirty-nine cycles were studied in patients with a history of endometriosis who went through in vitro fertilization. In 15 cycles, there was no evidence of endometriosis; in 10 cycles, the patients had mild or moderate disease; in 14 cycles, severe or extensive endometriosis was found. The pregnancy rates per cycle were 33%, 60%, and 7%, respectively (groups I and II, no significant difference; groups II and III, P less than 0.01). The difference was due to the different number of oocytes aspirated at laparoscopy because of technical problems in the cases with severe and extensive disease. There was also a significant difference in the number of pregnancies per transferred cycles. There was no difference in the luteal phase in the three groups. The reproductive potential, which seemed to be similar in groups I and II, was severely impaired in the group with severe endometriosis.

Topics: Adult; Embryo Transfer; Endometriosis; Estradiol; Female; Fertilization in Vitro; Humans; Infertility, Female; Luteal Phase; Menotropins; Oocytes; Ovulation Induction; Pregnancy; Progesterone

There seems to be an association of first-trimester spontaneous abortion and untreated endometriosis. In this report, 52% of an untreated group of patients with endometriosis aborted. However, 12% of a second group of surgically treated patients and 7% of a third group of patients treated with danazol aborted. Therefore, either medical or surgical therapy for endometriosis lowers the abortion rate significantly.

Topics: Abortion, Spontaneous; Chorionic Gonadotropin; Clomiphene; Danazol; Endometriosis; Female; Humans; Infertility, Female; Menotropins; Pregnancy; Pregnancy Complications, Neoplastic; Progesterone

Topics: Adnexa Uteri; Adnexal Diseases; Adult; Anovulation; Chorionic Gonadotropin; Danazol; Endometriosis; Female; Humans; Infertility; Laparoscopy; Laparotomy; Male; Menotropins; Ovarian Neoplasms; Pregnancy; Pregnancy, Tubal; Preoperative Care; Urinary Bladder Neoplasms

Topics: Clomiphene; Endometriosis; Fallopian Tubes; Female; Genital Diseases, Female; Humans; Infertility, Female; Menotropins; Ovarian Diseases; Ovulation; Pregnancy; Uterine Cervical Incompetence; Uterine Neoplasms