Dienogest treatment after ovarian endometrioma removal in infertile women prior to IVF

Abstract

Background: Severe forms of genital endometriosis are known to be associated with infertility and its subsequent treatment failure. Both gonadotropin-releasing hormone analogs (a-GnRH) and dienogest have been suggested as additional hormone therapy for patients with endometriomas. However, the result of hormonal suppression before an in vitro fertilization (IVF) cycle remains undetermined. Materials and methods: A prospective cohort study of 144 infertile women planning IVF after laparoscopic surgery of ovarian endometriomas was conducted at our department in 2012-2015. Patients were divided into three groups: group I (N ¼ 38) with dienogest course, group II (N ¼ 70) with a-GnRH group III (N ¼ 70) without any hormonal therapy within 6 months preceding IVF. Results: The study groups did not differ by removed endometriomas size and ovarian reserve indicators. The gonadotropin dose per Cycle was higher, while the number of retrieved oocytes was lower in group III patients (p < .001). In women with dienogest pretreatment, clinical pregnancy rate was 2.5 times (44.7% versus 16.7%, p ¼ .012) and delivery rate -three times higher (36.8% versus 11.1%, p ¼ .013) as compared with those from group III. Conclusions: The present study confirms the necessity of pre-cycle medical interventions in women with ovarian forms of endometriosis undergoing IVF. We suggest dienogest to be possibly more efficient treatment option for this kind of patients.

Effect of Postoperative Hormonal Suppression on Fertility in Patients With Endometriosis After Conservative Surgery

“…36,38 Surgical approach was by laparoscopy (n=13), 15,26–33,39–42 laparotomy (n=3), 34,36,38 or either one (n=3). 14,35,37 Four trials 28,31,40,41 included only patients with American Society for Reproductive Medicine Revised Classification of Endometriosis 21 stage 1 or 2, seven trials 15,29,30,32,34,37,38 included only patients with stage 3 or 4, and eight trials 14,26,27,33,35,36,39,42 included all stages. In seven trials, 14,29,30,32,36,39,42 only a subgroup of patients attempted pregnancy after surgery and were included in the analyses.…”

Clinical practice guidelines for endometriosis in Japan (The 3rd edition)

“… 2 In an RCT, which compared 6 months of administration of dienogest (2 mg/day) and triptorelin (3.75 mg/month) to no treatment, the dienogest group had significantly higher pregnancy rate and delivery rate compared to the non‐treatment group (44.7% vs. 16.7% and 36.8% vs. 11.1%, respectively), while the triptorelin group did not have significant differences with the no‐treatment group. 3 In addition to these studies, a Chinese group published a protocol for and began an RCT involving 1–2 months of GnRH agonists in 2018, 4 while a Dutch group published a protocol for and began an RCT involving 6 months of OCs/LEPs or GnRH agonists in 2019 5 ; reports of results from these RCTs are awaited. Although not a hormone preparation, an RCT reported that the PPAR‐γ agonist, pioglitazone, during the ovarian stimulation cycles resulted in significantly higher implantation rates than in patients who did not receive pioglitazone.…”

Impact of Adenomyosis on Infertile Patients—Therapy Options and Reproductive Outcomes

“…All of the women had undergone laparoscopic surgery for ovarian endometriomas previously. Women who received DNG pretreatment had a 2.5-fold higher clinical pregnancy rate (44.7% versus 16.7%, p = 0.012), and a three-fold higher delivery rate (36.8% versus 11.1%, p = 0.013) than controls [ 55 ].…”