Couples with mild male factor infertility and at least 3 failed previous IVF attempts may benefit from laparoscopic investigation regarding assisted reproduction outcome

Abstract

the aim of this study is to assess the value of laparoscopy for couples diagnosed with mild male factor infertility and at least three previous failed In-Vitro Fertilization (IVF) attempts. A total of 169 couples were included in this prospective cohort study. patients were presented with the option of being subjected to laparoscopic investigation for correction of previously unidentified endometriosis or pelvic adhesions. The outcome measures were Live Birth/Ongoing Pregnancy, clinical pregnancy and positive hCG rate. One-hundred and one of them opted for, whereas 68 opted against laparoscopic investigation. All patients proceeded with a single ICSI cycle. Following laparoscopic investigation, 43 patients were diagnosed with endometriosis, 22 with adhesions, while for 36 patients laparoscopic investigation provided no further diagnosis. No statistically significant differences were observed regarding baseline hormonal levels and other characteristics between the two groups and the three subgroups. When compared to the no-laparoscopy group, women subjected to laparoscopy presented with a higher clinical pregnancy and ongoing pregnancy/live birth rate. following endometriosis correction, a marginally non-statistically significant trend was observed regarding a decrease in poorquality blastocysts (p = 0.056). A statistically significant higher clinical pregnancy (p = 0.03) and ongoing pregnancy/live birth rate was observed in the endometriosis group when compared to male factor infertility only (p = 0.04). Laparoscopic identification and correction of undiagnosed endometriosis in couples initially diagnosed with male infertility and at least 3 failed previous IVF attempts, appears to be a promising approach efficiently addressing infertility for these patients while avoiding IVF overuse.Male factor infertility stands as a common infertility etiology, identified in up to 50% of infertile couples 1 , as the sole etiology or coupled with female factor infertility. Studies on male factor infertility, provide robust data that this may be successfully managed through in vitro fertilization (IVF) treatment, ensuring high implantation and pregnancy rates 2 . In fact, even severe and challenging cases of male factor infertility could be effectively managed, through the employment of a wide pallet of techniques improving standard employment of Intracytoplasmic Sperm Injection (ICSI) along with fertilization rates 3 . Male infertility has been categorized as mild, moderate or severe 4 . Mild male factor infertility does not present with a strict definition, including a range of different

Getting to Know Endometriosis-Related Infertility Better: A Review on How Endometriosis Affects Oocyte Quality and Embryo Development

“…NICE guidelines do not comment on the usefulness of laparoscopic surgery prior to IVF treatment in order to improve IVF outcomes [ 101 ]. However, studies performed in the Greek population provide data indicating that undiagnosed endometriosis could be underlying behind unexplained infertility, and laparoscopic diagnosis and correction of underlying pathologies could significantly improve reproductive outcome of these patients [ 1 , 2 ]. Considering the aforementioned, it is unclear which treatment strategy could improve oocyte and embryo quality improving reproductive system functionality.…”

“…It is clear that where endometriosis-related infertility is concerned, the asymptomatic nature of the underlying disorder complicates things. This harbors the risk of a false unexplained infertility diagnosis and subsequent futile in vitro fertilization (IVF) attempts [ 1 , 2 ]. It is estimated that 30–50% of women with endometriosis are infertile [ 3 ], while it has been suggested that 20–50% of subfertile women are diagnosed with endometriosis [ 4 , 5 ].…”

Endometriosis Associated Infertility: A Critical Review and Analysis on Etiopathogenesis and Therapeutic Approaches

“…Newer studies suggest that laparoscopic surgery as an investigative and corrective tool of the underlying pathologies prior to initiating numerous and various therapeutic attempts, should be taken into consideration for women suffering from unidentified infertility etiology, as it can greatly impact the outcome, as well as improving the overall costs of the lengthy treatment plan and ultimately the quality of life of the women going through this journey towards child conceiving [ 181 ]. The same view on laparoscopic investigation prior to concentrating on assisted reproduction techniques is shared when focusing on mild male factor infertility cases, especially if previous failed IVF have attempts attributed to an infertility etiology [ 182 ].…”