Determining the Fertility Benefit of Controlled Ovarian Hyperstimulation With Intrauterine Insemination After Operative Laparoscopy in Patients With Endometriosis

作者：Gandhi Anjalika R; Carvalho Luiz Fernando; Nutter Benjamin; Falcone Tommaso^*

来源：Journal of Minimally Invasive Gynecology, 2014, 21(1): 101-108.

DOI：10.1016/j.jmig.2013.07.009

• ASRM staging system
• Controlled ovarian hyperstimulation
• Endometriosis
• Intrauterine insemination
• Laparoscopy

Study Objective: To determine the fertility benefit of controlled ovarian hyperstimulation (COH) and intrauterine insemination (IUI) in surgically treated endometriosis.
Design: Retrospective cohort study (Canadian Task Force classification II-2).
Setting: Cleveland Clinic Foundation, tertiary care center.
Patients: Ninety-six women of reproductive age who underwent operative laparoscopy to treat endometriosis-related infertility (endometriosis stage I/II n = 67; stage III/IV n = 29) from 2001 to 2011 at the Cleveland Clinic Foundation.
Interventions: COH via letrozole, clomiphene, or gonadotropins, with or without IUI.
Measurements and Main Results: Kaplan-Meier estimations of cumulative pregnancy rates were compared by stage between COH/IUI and spontaneous cycles. Patients with stage I/II endometriosis attempted spontaneous pregnancy for 669 months and 216 COH + IUI cycles, and patients with stage III/IV endometriosis attempted spontaneous pregnancy for 379 months and 74 COH + IUI cycles. Crude pregnancy rates were 45.7% in stage I/II and 40.5% in stage III/IV. Twelve-month cumulative pregnancy rates in stage I/II were 45% for spontaneous attempts and 42% for COH + IUI and in stage III/IV were 20% for spontaneous attempts and 10% for COH + IUI (not significant). Cumulative pregnancy rates for COH/IUI in stage I/II were significantly higher than in stage III/IV. Monthly fecundity rates were 3.81% for stage I/II spontaneous, 4.59% for COH/IUI 3.05% for stage III/IV spontaneous, and 1.68% for COH/IUI (not significant).
Conclusions: COH + IUI did not improve pregnancy rates in any stage of endometriosis. In stage III/IV we recommend postoperative in vitro fertilization.

• 出版日期2014-2