scholarly journals The Significance of Planned Fertility Preservation for Women With Endometrioma Before an Expected Ovarian Cystectomy

2021 ◽  
Vol 12 ◽  
Author(s):  
Yeon Hee Hong ◽  
Hyun Kyoung Lee ◽  
Seul Ki Kim ◽  
Jung Ryeol Lee ◽  
Chang Suk Suh

Endometrioma is known to reduce the ovarian reserve and the extent of the decrease is more severe when ovarian surgery is performed. Therefore, to prevent this decline in fertility, patients with endometrioma are considered candidates for preoperative fertility preservation (FP). In this study, we evaluate the efficacy of FP in women with endometrioma before planned ovarian surgery. A total of 95 cycles in 62 patients with endometrioma, undergoing controlled ovarian stimulation (COS) for FP using a gonadotropin-releasing hormone (GnRH) antagonist protocol before an expected ovarian surgery, were enrolled retrospectively. COS outcomes were compared according to endometrioma laterality. Additionally, first COS cycle outcomes in patients with endometrioma were compared with those in infertile patients, or in patients with a benign ovarian cyst using propensity score matching. When multiple COS cycles were performed, the results of cumulative cycles were analyzed. Embryo quality was worse in the bilateral endometrioma group. Compared with the infertile patient group, the patients with endometrioma had significantly lower Anti-Müllerian Hormone (AMH) and fewer numbers of oocytes retrieved (median, 3.3 vs. 1.2, p<0.001; 7.0 vs. 4.0, p=0.009, respectively). Compared with mature oocytes in infertile patients or patients with a benign cyst, mature oocytes were fewer in patients with endometrioma, but this was not statistically significant (median, 4.0 vs. 3.0, p=0.085; 5.5 vs. 3.0, p=0.052, respectively). The median value of the cumulative number of cryopreserved oocytes or embryos was 14.5 up to the fourth cycle compared to 3 up to the first cycle, with cumulative effect. Women with endometrioma should be counseled for FP before planned ovarian cystectomy. The number of cryopreserved oocytes or embryos can be increased by repeated cycles.

2019 ◽  
pp. 1-8

Abstract Poor ovarian response (POR) is a multifactorial problem with less ovarian reserve and its incidence varies between 9% and 24%, therefore, early identification is It is better to reduce the risk of cycle cancellation as well as side effects. Purpose: To compare the use of Gonadotropin-releasing hormone GnRH flare-up versus GnRH antagonist protocol, in poor responders preparing for Intra Cytoplasmic Sperm Injection ICSI, as regards embryo quality, cycle parameters and clinical outcomes. Patients and methods: RCT included one hundred and six qualified poor responders performing ICSI were divided into 2 groups each containing 53 patients. Group 1 received GnRH flare-up protocol and group 2 received GnRH antagonist protocol. Data were collected for both groups. Results: No significant difference was found between both groups as regards patient age (p value 0.4), body mass index (p value 0.5), day 3 FSH level (p value 0.06), infertility cause, number of oocytes and MII oocytes and number of embryos transferred. Significant difference was found in the number of gonadotropin ampoules with less ampules in the flare-up group, 64 versus 76 ampules, peak estradiol level, which was higher in the flare-up group, 1192 versus 798 and the quality of embryos in favor of GnRH flare-up group (P-value= 0.017, 0.009 and 0.044) respectively. No significant difference was found in pregnancy and miscarriage rates (p value 0.90 and 0.87 respectively). Conclusion: Flare-up protocol is more effective than GnRH antagonist protocol as regards the improved embryo quality, with more top-quality embryos in the flare-up protocol group.


2015 ◽  
Vol 2015 ◽  
pp. 1-6 ◽  
Author(s):  
Gayem İnayet Turgay Çelik ◽  
Havva Kömür Sütçü ◽  
Yaşam Kemal Akpak ◽  
Münire Erman Akar

Objective. To compare the effectiveness of a flexible multidose gonadotropin-releasing hormone (GnRH) antagonist against the effectiveness of a microdose flare-up GnRH agonist combined with a flexible multidose GnRH antagonist protocol in poor responders to in vitro fertilization (IVF).Study Design. A retrospective study in Akdeniz University, Faculty of Medicine, Department of Obstetrics and Gynecology, IVF Center, for 131 poor responders in the intracytoplasmic sperm injection-embryo transfer (ICSI-ET) program between January 2006 and November 2012. The groups were compared to the patients’ characteristics, controlled ovarian stimulation (COH) results, and laboratory results.Results. Combination protocol was applied to 46 patients (group 1), and a single protocol was applied to 85 patients (group 2). In group 1, the duration of the treatment was longer and the dose of FSH was higher. The cycle cancellation rate was significantly higher in group 2 (26.1% versus 38.8%). A significant difference was not observed with respect to the number and quality of oocytes and embryos or to the number of embryos transferred. There were no statistically significant differences in the hCG positivity (9.5% versus 9.4%) or the clinical pregnancy rates (7.1% versus 10.6%).Conclusion. The combination protocol does not provide additional efficacy.


2005 ◽  
Vol 84 ◽  
pp. S251-S252
Author(s):  
J.L. Eaton ◽  
A. Zimon ◽  
T. Von Wald ◽  
M. Goldman ◽  
M.M. Alper ◽  
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