ivf - icsi Öncesİ endometriomalar Çikartilmali mi?

8/14/2019 Ivf - Icsi nces Endometriomalar ikartilmali Mi?

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IVF - ICSI NCES

ENDOMETRIOMALARIKARTILMALI MI?

Prof. Dr. Blent Baysal.. stanbul Tp Fakltesi


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Prevalans: kadnlarn %5 inde, infertiliteproblemi olan kadnlarn %30-50 sinde


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KSTEKTOMNN OVER REZERVNEETKS ??


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IVF-ICSI outcome in women operated on forbilateral endometriomas.Somigliana E,et al.Hum Reprod. 2008

68 cases (bilat. cystectomy)- 136 controls

the number of follicles (P = 0.006), oocytes retrieved

(P = 0.024) and embryos obtained (P = 0.024) weresignificantly lower.

The clinical pregnancy rate per started cycle in casesand controls was 7% and 19% (P = 0.037)

CONCLUSIONS: IVF outcome is significantly impaired inwomen operated on for bilateral ovarian endometriomas.


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Studies evaluating response to ovarian stimulation in patients previously operated forendometriomas (EM)

AuthorSurgical technique olgu oosit embryo gebelik

EM Ctr EM Ctr EM Ctr EM (%) Ctr (%)

Al-Azemi etal. (2000)*

Not reported 40 80 6.9 0.7 7.1 0.5 NA NA 15 15

Canis et al.

(2001)

Cyst

enucleation

41 59 9.4 6.2 10.9 6.5 4.7 3.6 5.8 4.9 36 30

Donnez et al.(2001)

Laservaporization

85 289 10.6 4.2 8.6 6.3 4.4 3.2 4.0 3.6 37 35

Marconi etal. (2002)

Cystenucleation

39 36 7.5 3.9 8.7 5.1 3.8 0.8 3.6 1.2 38 33

Geberet al.(2002)

37 46 12.0 5.9 NA NA 53 56

Pabucco etal. (2004)

Cystenucleation

44 46 7.2 1.5 NA NA 25 30


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End.karlm 147 sikls - %25.4 gebelikkarlmam 63 sikls - %22.7 gebelik(p=0.776)(Fertil Steril 2004)


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Effect of endometrioma cystectomy on IVFoutcome: a prospective randomized study.

Demirol A, Reprod Biomed Online. 2006

prospectively randomized

group I (49 patients) - ovarian surgery before ICSI

group II (50 patients) -ICSI cycle directly

Group 1- lower oocyte number

There was no difference in terms of fertilization

(86% in group I and 88% in group II), implantation(16.5% in group I and 18.5% in group II)

pregnancy rates (34% in group I and 38% group II).


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Outcome of in vitro fertilization/intracytoplasmicsperm injection after laparoscopic cystectomy forendometriomas.

Yaral et al. Fertil Steril 2006 unilateral (n = 34)

bilateral (n = 23) laparoscopic cystectomy

control group (n= 99 ) tubal factor infertility

The mean number of oocytes, metaphase II oocytes, and

two-pronucleated oocytes were significantly lower in the

bilateral cystectomy group

fertilization rate, the mean number of embryos

transferred, the mean number of grade 1 embryos

transferred, the clinical PR/ET, implantation rate, were

comparable among the three groups.


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Laparoscopic resection or sonography-guidedvaginal aspiration of endometriomas prior to ICSI-ET does not worsen treatment outcomesTavmergen E , et al. Clin Exp Obstet Gynecol. 2007;

resection group (Group I) 36 cycles ;

aspiration (Group II) - 26 cycles

control group (Group III) - 53 cycles - tubal factor Gonadotropin consumption was higher, peak estradiol

level lower, the number of oocytes less in the

laparascopic resection group (Group I) with respect to

the control group. laparascopic endometrioma resection, transvaginal

ultrasound-guided endometrioma cyst aspiration

do not worsenthe treatment outcome.


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Impact of ovarian endometrioma on assistedreproduction outcomes.Gupta S. Reprod Biomed Online. 2006

Metaanalysis

The odds forclinical pregnancy were not affectedsignificantly in patients with ovarian endometriomacompared with controls, with an overall odds ratio of 1.07from three studies [95% CI: (0.63-1.81), P = 0.79].


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The effect of surgical treatment for endometriomaon in vitro fertilization outcomes: a systematicreview and meta-analysis.Tsoumpou I, .UK Fertil Steril 2008

A systematic review and meta-analysis

three electronic databases - 1985 - 2007

20 eligible studies. Meta-analysis - five studies that compared surgery vs.

no treatment of endometrioma.

There was no significant difference in clinical pregnancy

rate between the treated and the untreated groups. no significant difference -to controlled ovarian

hyperstimulation with gonadotrophins


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Should endometriomas be treated before

IVF-ICSI cycles?Somigliana E, et al. Human Reprod Update 2006

The idea that surgery increases IVF pregnancy rates is

not supported by the available evidence. However, the chance of conception is not the only issue

that has to be considered.


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Somigliana, E. et al. Hum Reprod Update 2006 12:57-64; doi:10.1093/humupd/dmi035

Pros and cons of surgical treatment of endometriomas beforeIVF-ICSI cycles


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Copyright restrictions may apply.

Vercellini, P. et al. Hum. Reprod. 2008 0:den379v1-15; doi:10.1093/humrep/den379

Pregnancy rates observed after laparoscopic excision of endometriomas


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Management of endometriomas in womenrequiring IVF: to touch or not to touch.Garcia-Velasco JA. Human Reprod 2008

proceeding directly to IVF to reduce time to pregnancy,

to avoid potential surgical complications and to limit

patient costs.

Surgery should be envisaged only in presence of

*large cysts,

*pain symptoms which are refractory to medicaltreatments,

*malignancy cannot reliably be ruled out


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International guidelines on surgical treatment ofendometriosis-associated infertility in asymptomatic women.

ESHRE 2005 ASRM 2006 RCOG 2006

Minimal-mild endometriosis(stage III disease)

Limited benefit: surgery recommended Small benefit: surgery recommended Demonstrated benefit: surgeryrecommended

Moderatesevereendometriosis (stage III-IVdisease)

Possible but unproven benefit: surgeryrecommended

Possible benefit: surgery recommended Possible benefit: recommendationuncertain

Post-operative adjuvanttreatment

No benefit: not recommended No benefit: not recommended No benefit: not recommended

Surgery before IVF 4 cm Doubtful benefit: no recommendation 4 cm

Recurrent endometriosis No recommendation Second-line surgery not recommended No recommendation


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1- IVF ncesi cerrahi zorunlu deil2-Semptom varsa opere edilebilir

3-Hastann kaderini belirlemede ilkoperasyon ok nemli

Sonu

ivf - icsi Öncesİ endometriomalar Çikartilmali mi?

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