Research question The major causes of in vitro fertilization (IVF) failure in women with endometriosis have been attributed to decreased ovarian reserve, low quality of embryos and impaired receptivity of endometrium. Dienogest (DNG) has anti-inflammatory and anti-angiogenic activity; thus, it may theoretically improve IVF outcomes in women with endometriosis. This study aimed to evaluate the administration of DNG before IVF in women with endometriosis who previously failed one IVF cycle. Methods This study was based on the retrospective analysis of a prospectively collected database, including 151 women who failed a previous IVF cycle and all subsequent embryo transfers and had imaging diagnosis of endometriosis. Patients either directly underwent IVF without receiving hormonal treatment or received a three-month treatment with DNG (2 mg/daily) before IVF. Results Eighty-eight (58.2%) patients underwent IVF without previous hormonal treatment, and sixty-three (41.8%) received pretreatment with DNG. The cumulative implantation, clinical pregnancy, and live birth rate rates were significantly higher in the DNG-treated group (39.7%, 33.3%, and 28.6%) than in the non-treated group (23.9%, 18.2%, and 14.8%; p=0.049 e p=0.037, p=0.043, respectively). The largest diameter of endometriomas significantly decreased after DNG pretreatment (p<0.001). The use of DNG increased significantly the number of oocytes retrieved (p=0.031), 2PN embryos (p<0.039), and blastocysts (p=0.05) in women with endometriomas with diameter ≥ 4 cm. Conclusions The findings from this study suggest that in patients with endometriosis, the outcomes of IVF can be improved by pretreatment with DNG. In particular, the use of DNG allows for better oocyte retrieval and blastocysts in patients with large endometriomas.
Pretreatment with dienogest in women with endometriosis undergoing in vitro-fertilization after a previous failed cycle
Simone Garzon;
2020-01-01
Abstract
Research question The major causes of in vitro fertilization (IVF) failure in women with endometriosis have been attributed to decreased ovarian reserve, low quality of embryos and impaired receptivity of endometrium. Dienogest (DNG) has anti-inflammatory and anti-angiogenic activity; thus, it may theoretically improve IVF outcomes in women with endometriosis. This study aimed to evaluate the administration of DNG before IVF in women with endometriosis who previously failed one IVF cycle. Methods This study was based on the retrospective analysis of a prospectively collected database, including 151 women who failed a previous IVF cycle and all subsequent embryo transfers and had imaging diagnosis of endometriosis. Patients either directly underwent IVF without receiving hormonal treatment or received a three-month treatment with DNG (2 mg/daily) before IVF. Results Eighty-eight (58.2%) patients underwent IVF without previous hormonal treatment, and sixty-three (41.8%) received pretreatment with DNG. The cumulative implantation, clinical pregnancy, and live birth rate rates were significantly higher in the DNG-treated group (39.7%, 33.3%, and 28.6%) than in the non-treated group (23.9%, 18.2%, and 14.8%; p=0.049 e p=0.037, p=0.043, respectively). The largest diameter of endometriomas significantly decreased after DNG pretreatment (p<0.001). The use of DNG increased significantly the number of oocytes retrieved (p=0.031), 2PN embryos (p<0.039), and blastocysts (p=0.05) in women with endometriomas with diameter ≥ 4 cm. Conclusions The findings from this study suggest that in patients with endometriosis, the outcomes of IVF can be improved by pretreatment with DNG. In particular, the use of DNG allows for better oocyte retrieval and blastocysts in patients with large endometriomas.
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