Pretreatment with Dienogest in women with Endometriosis undergoing IVF after a previous failed cycle
Endometriosis is a benign chronic inflammatory estrogen-dependent disease and a well-known cause of infertility. Endometriosis may have a direct harmful effect on fertility not only due to the presence of adhesions and anatomic distortions, but also because of the intrinsic negative impact on oocyte development, embryogenesis, or implantation.
Removal of endometriomas in infertile patients is controversial, considering also the risk of damaging ovarian reserve. Women with endometriosis may undergo in vitro fertilization (IVF) and embryo transfer for increasing the chance to conceive.
KEY POINTS
➣ IVF has worse outcomes in patients with endometriosis.
➣ The prolonged use of hormone drugs before IVF may improve pregnancy outcomes.
➣ Dienogest (DNG) is a progestin with anti-inflammatory and anti-angiogenic activity.
➣ Implantation rates may be higher as a result of receiving DNG before IVF.
➣ Clinical pregnancy rates may be higher as a result of receiving DNG before IVF.
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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. Thus, the use of prolonged courses of hormone therapy may represent a suitable strategy of overcoming infertility related to endometriosis.
In recent years, dienogest (DNG), a fourth-generation progestin, has been widely employed for treating pain due to endometriosis. As it has anti-inflammatory and anti-angiogenic activity, this drug may improve outcomes in women with endometriosis undergoing IVF.
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%; respectively). The largest diameter of endometriomas significantly decreased after DNG pretreatment. The use of DNG increased significantly the number of oocytes retrieved 4, 2PN embryos, and blastocysts 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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