Effectiveness of postoperative adjuvant therapy in improving reproductive outcome of endometriosis-associated infertility

Citation
Kc. Lin et al., Effectiveness of postoperative adjuvant therapy in improving reproductive outcome of endometriosis-associated infertility, J FORMOS ME, 100(7), 2001, pp. 466-470
Citations number
27
Language
INGLESE
art.tipo
Article
Categorie Soggetti
General & Internal Medicine
Journal title
JOURNAL OF THE FORMOSAN MEDICAL ASSOCIATION
ISSN journal
0929-6646 → ACNP
Volume
100
Issue
7
Year of publication
2001
Pages
466 - 470
Database
ISI
SICI code
0929-6646(200107)100:7<466:EOPATI>2.0.ZU;2-J
Abstract
Background and purpose: Treatment of endometriosis-associated infertility h as not yet become standardized. Various protocols including surgical treatm ent, medical therapy, and a combination of both have been suggested but the ir use remains controversial. The objective of the present study was to det ermine whether postoperative adjuvant therapy for endometriosis is effectiv e in improving reproductive outcome. Methods: Medical records of infertile patients with newly diagnosed endomet riosis treated in a university teaching hospital during a 50-month period w ere reviewed. After exclusion of patients with other major infertility fact ors, a total of 209 patients were included in the retrospective analysis. T hese patients were divided into those receiving (n = 78) or not receiving ( n = 131) peri- or postoperative adjuvant medical therapy. The adjuvant ther apies included danazol (n = 62), gonadotropin releasing hormone analogues ( n = 11), progestins (n = 3), oral contraceptives (n = 1), and mixed treatme nt (n = 1). Results: The pregnancy rate was lower in those receiving adjuvant therapy, although this result was not significant (32.1% vs 45.8%; p = 0.05). When p atients using postoperative danazol therapy were considered alone, the preg nancy rate in patients receiving adjuvant therapy was significantly lower t han that in patients not receiving it (p = 0.047). When the stage of endome triosis was considered, the pregnancy rate in patients receiving adjuvant t herapy was again lower than in those not receiving it in patients with mini mal or mild endometriosis (42.9% vs 60%; P = 0.043). However, in patients w ith moderate or severe endometriosis, the pregnancy rate was not different in the two groups (31% vs 36%; p = 0.56). Postoperative assisted reproducti ve techniques (ART) including controlled ovarian hyperstimulation/intrauter ine insemination (COH/IUI) and in vitro fertilization (IVF) were effective in improving the pregnancy rates for all patients (53.9% with ART vs 33.1% without; P = 0.003) and for patients with advanced endometriosis (47.7% wit h ART vs 27.2% without; p = 0.016). Conclusions: Our results suggest that postoperative adjuvant therapy is ine ffective in improving reproductive outcome in patients with either early (m inimal or mild) or advanced (moderate and severe) endometriosis. This findi ng suggests that if fertility is the goal of treatment, adjuvant therapy ma y be unnecessary after surgery. In contrast, our data suggest that empirica l ART, including COH/IUI or IVF, may be a better alternative to improve the pregnancy outcome after surgery.