scholarly journals The Role of Laparoscopic Investigation in Enabling Natural Conception and Avoiding in vitro Fertilization Overuse for Infertile Patients of Unidentified Aetiology and Recurrent Implantation Failure Following in vitro Fertilization

2019 ◽  
Vol 8 (4) ◽  
pp. 548 ◽  
Author(s):  
Agni Pantou ◽  
Mara Simopoulou ◽  
Konstantinos Sfakianoudis ◽  
Polina Giannelou ◽  
Anna Rapani ◽  
...  
Keyword(s):  
Laparoscopic Surgery ◽  
In Vitro Fertilization ◽  
Primary Outcome ◽  
Unexplained Infertility ◽  
Vitro Fertilization ◽  
Natural Conception ◽  
Infertility Patients ◽  
Infertile Patients

The present study aims to explore the effectiveness of laparoscopic surgery on women presenting with infertility, of unidentified aetiology according to the standard infertility investigation, and recurrent failed In Vitro Fertilization (IVF) attempts. Identifying and correcting possible underlying pathologies by laparoscopy may subsequently enable natural conception in an effort to address infertility and avoid IVF overuse. One-hundred and seven (107) women with unidentified aetiology of infertility and recurrent failed IVF attempts met the inclusion criteria. Laparoscopic surgery was performed as the endpoint of the patients’ diagnostic journey, aiming to identify a possible underlying factor as the cause of infertility. Sixty-two (62) out of 107 patients (57.94%) that underwent laparoscopy were diagnosed with endometriosis, 25 out of the 107 patients (23.3%) were diagnosed with periadnixal and pelvic adhesions, and 20 cases (18.69%) presented with no pathology and remained unexplained. Following identification and correction of endometriosis and pelvic adhesions, patients were invited to conceive naturally. For the patients that laparoscopic investigation failed to reveal any pathology they were categorized as unexplained infertility and were subjected to a single IVF cycle. Natural conception success rate within the first postoperative year was the primary outcome. Within the first postoperative year, 30 out of 62 patients (48.38%) diagnosed with endometriosis following laparoscopic investigation achieved a natural conception, and 28 out of them (93.4%) reported live-births. Additionally, 11 out of 25 patients (44%) diagnosed with periadnixal and pelvic adhesions achieved natural conception within the first operative year. Regarding the group of unexplained infertility patients, only four out of the 20 patients (20%) achieved clinical pregnancy in the first post-operative IVF cycle. In conclusion, laparoscopy appears to be a promising approach, addressing infertility, providing significant diagnostic findings, while avoiding IVF overuse regarding patients of unidentified infertility presenting with recurrent failed IVF attempts.

The role of in vitro fertilization in infertile patients with endometriosis

1985 ◽  
Vol 44 (1) ◽  
pp. 56-61 ◽  
Author(s):  
Claudio F. Chillik ◽  
Anibal A. Acosta ◽  
Jairo E. Garcia ◽  
Sixto Perera ◽  
Jan F.H.M. Van Uem ◽  
...  
Keyword(s):  
In Vitro Fertilization ◽  
Vitro Fertilization ◽  
Infertile Patients

Unexplained infertility and expectant management in women aged 39 or above: is it acceptable to ask couples to wait one year before receiving IVF? A retrospective cohort study

2020 ◽  
Author(s):  
Andrea Roberto Carosso ◽  
Rik van EEKELEN ◽  
Alberto Revelli ◽  
Stefano CANOSA ◽  
Noemi MERCALDO ◽  
...  
Keyword(s):  
In Vitro Fertilization ◽  
Live Birth ◽  
Expectant Management ◽  
Unexplained Infertility ◽  
Vitro Fertilization ◽  
Age Related ◽  
Significant Difference ◽  
Natural Conception ◽  
One Year

Abstract Background: in older women, it is difficult to distinguish between ‘true’ unexplained infertility and age-related infertility. Unexplained infertile couples can have further expectant management before starting assisted reproductive treatments to avoid unnecessary, invasive and expensive treatment. However, ovarian reserve rapidly declines after 39 years or more, as the live birth rate after in vitro fertilization. It is thus uncertain if such a waiting policy, is also appropriate for women of advanced age.Methods: couples who had access to a waiting list for approximately one year before receiving reimbursed public IVF were compared with those paying for access to immediate private treatment at the IVF unit of S. Anna academic hospital and its private appendix. To allow for comparisons between these two strategies, we followed up couples who opted to pay for one year after the last embryo transfer from their first cycle. Clinical procedures regarding diagnosis and treatment were the same for both groups. We calculated the proportion of live births in both groups and compared these using a two-sample Z test for equality of proportions. The imbalance between these groups in terms of prognosis was accounted for using inverse probability weighting.Results: 635 couples were evaluated. Out of 359 couples in the immediate group, 70 (19.5%) had a live birth of which 11 after natural conception and 59 after IVF. Out of 276 couples in the waiting group, 57 (20.7%) had a live birth of which 37 after natural conception and 20 after IVF. There was no statistically significant difference between the two strategies in terms of the cLBR (19.5% immediate versus 20.7% waiting, 95% CI for difference: -0.07to 0.05), also after weighting (16.8% immediate versus 26.6% waiting, bootstrap 95%, CI for difference: -0.20 to 0.01).Conclusion(s): the cLBR for the ‘waiting before in vitro fertilization’ and the ‘immediate’ strategies were similar. Further studies are necessary to validate these findings and to better characterize these patients in order to individualize treatment and optimize economic resources, particularly in a setting of publicly-funded IVF.Trial registration: retrospectively registered

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