51 ART : assisted reproductive technologies ART ART AID I ART ART ART Adjusted odds ratio End. Endo. vs all others vs Tubal Stage vs Tubal Stage vs Tubal Pregnancy rate Fertilization rate Implantation rate Number of oocytes P comparing endometriosis with control group in every outcome category. Fertility and Sterility
52 ART Origin of oocytes Cycles Pregnancytransfer Implantation rate Fertile women Poly cystic ovaries Unknown Tubal factor Male factor Endometriosis P: Compared to others Human Reproduction ART Endometriosis Control P value Stage n n Recipient age Number of good embryos transferred Clinical pregnancy rate Implantation rate Miscarriage rate Live birth Fertility and Sterility Group I Endometriosis Group II Obstruction Pvalue Number of follicles Follicular diametermm AMHng/ml 4 3 2 1 End P<.5 Obs AMH/Follicleng/ml.6.5.4.3.2.1 P<.1 End Obs Fertility and Sterility AMH ART PCO ART AMH AMH ART ART Aboulghar
ART 53 Canis1 Marconi2 6 5 3 1 Aboulghar3 Garcia-V4 Fertility and Sterility Loo5 Yazbeck6 Esinler6 Control Post surgery ART ART ART ART In vitro ART ART ESHREASRM RCOG cm ART ART ART vs P vs.
54 Stage ART ART Endometriosis Tubal factor P value after surgery Number of IVF cycles FSHHMG amp. required Peak E levelspgml Number of follicles mm Number of oocytes retrieved Number of embryos on day Clinical pregnancy rate cycle Clinical pregnancy rate ET Implantation rate Miscarriage rate Fertility and Sterility Stage ART ART Stages of endometriosis Number of patients Before surgery After surgery Days of stimulation Number of oocytes Fertilization rateivf Fertilization rateicsi Number of cll on day Number of Blastocyst frozen All J Assisted Reprod Genet ART Preterm birth completed weeks of gestation SGA : Birth weight th percentile for any given gestation Preterm birth risk Small for gestational age Odds ratio CI Odds ratio CI Ovarian endometriomata Other endomtriosis ART non-endometriosis Reference Subfertile Fertile Reference Fertility and Sterility Clinical condition Minimal-mild : Stage III Moderate-severe : Stage IIIIV Post-operative vant treatment Surgery before IVF Recurrent endometriosis International guidelines Recommendation ESHRE ASRM RCOG Limited benefit: surgery Demonstrated benefit: Small benefit: surgery recommended surgery recommended Possible but unproven benefit : surgery recommended adju- No benefit : not recommended Possible benefit : Possible benefit : surgery recommended surgery recommended No benefit : not recommended No benefit : not recommended Recommended if endometrioma cm recommendation dometrioma cm Doubtful benefit : no Recommended if en- Second-line surgery No recommendation IVF Human Reproduction not recommended IVF No recommendation IVF vs. DORdiminished ovarian reserve vs.
ART 55 5 3 1 ART Endometriosis Endometriosis P value after surgery no surgery Number of IVF cycles Age FSHHMGIU Peak E levelspgml Duration before HCG Number of oocytes retrieved Fertilization rate Good day embryo rateoocyte Good blastocyst ratepn P<.5 n n ART vs. vs. ART Gn E vs. vs. vs. ART Endometrioma Endometrioma P value post alcohol tx no tx Number of IVF cycles Age FSHHMGIU Peak E levelspgml Duration before HCG Number of oocytes retrieved Fertilization rate Good day embryo rateoocyte Good blastocyst ratepn 5 45 36.2 42.4 3 1 No treatment Alcohl tx Fresh ET Frozen ET n n vs. ART DOR POF ART ART ART
56 5 5 3 3 1 ART Adenomyosis Control P value Number of IVF cycles Age FSH/HMGIU Peak E levelspg/ml Duration before HCG Number of oocytes retrieved Fertilization rate Good day embryo rate/oocyte Good blastocyst rate/pn 1 33.3.2 45.5 43.5 Control Adenomyosis Fresh ET Frozen ET n n 33.3 41.7 Adenomyosis Adenomyosis post sugery Fresh ET Frozen ET n n ART ART DOR cm DOR ART ART ART ART Barnhart K et al. Effect of endometriosis on in vitro fertilization. Fertil Steril Simon C et al. Outcome of patients with endometriosis in assisted reproduction : results from in-vitro fertilization and oocyte donation. Hum Reprod Lemos NA et al. Decreased anti-mullerian hormone and altered ovarian follicular cohort in infertile patients with mild/minimal endometriosis. Fertil Steril Diaz I et al. Impact of stage IIIIV endometriosis on recipients of sibling oocytes : matched casecontrol study. Fertil Steril Matalliotakis IM et al. Women with advancedstage endometriosis and previous surgery respond less well to gonadotropin stimulation, but have similar IVF implantation and delivery rates compared with women with tubal factor infertil-
ART 57 ity. Fertil Steril Garcia-Velasco JA et al. Removal of endometrioma before in vitro fertilization does not improve fertility outcomes: a matched, case-control study. Fertil Steril Tsoupmou I et al. The effect of surgical treatment for endometrioma on in vitro fertilization outcomes : a systematic review and meta-analysis. Fertil Steril Somigliana E et al. Should endometriomas be treated before IVF-ICSI cycles? Hum Reprod Vercellini P et al. Surgery for endometriosisassociated infertility : a pragmatic approach. Hum Reprod Shahine LK et al. Embryo quality before and after surgical treatment of endometriosis in infertile patients. J Assist Reprod Genet FertiFernando S et al. Preterm birth, ovarian endometriomata, and assited reproductive technologies. Fertil Steril Al-Azemi M et al. Ovarian response to repeated controlled stimulation in in-vitro fertilization cycles in patients with ovarian endometriosis. Hum Reprod Mathieu d Argent E et al. Results of first in vitro fertilization cycle in women with colorectal endometriosis compared with those with tubal or male factor infertility. Fertil Steril