Efficacy and safety of intrauterine insemination in patients with moderate-to-severe endometriosis

Abstract

Performing intrauterine insemination (IUI) in moderate-to-severe endometriosis patients is not implemented in international guidelines, as only limited data exist on treatment efficacy and safety. This retrospective study examined the efficacy and safety of two IUI treatment strategies performed between January 2007 and July 2012 in moderate-to-severe endometriosis patients. Eight (40.0%) versus seven (15.6%) ongoing pregnancies were accomplished in patients undergoing IUI with ovarian stimulation (n=20, 61 cycles) versus IUI without ovarian stimulation in the first three cycles followed by IUI with ovarian stimulation (IUI with natural/ovarian stimulation; n=45, 184 cycles). Preceding long-term pituitary down-regulation tended to result in a higher ongoing pregnancy rate (adjusted HR 1.8) and a higher chance of endometriosis recurrence (adjusted HR 2.3). Eight (40.0%) versus 16 (35.6%) recurrences of endometriosis complaints were reported in patients receiving IUI with ovarian stimulation versus IUI with natural/ovarian stimulation. IUI might be a valuable treatment in moderate-to-severe endometriosis patients and IUI with ovarian stimulation should be offered over IUI with natural/ovarian stimulation. Preceding long-term pituitary down-regulation might positively influence the ongoing pregnancy rate and can be considered. Whether this treatment strategy can be structurally offered prior to IVF must be investigated in a randomized controlled trial.

Non-ART pregnancy predictive factors in infertile patients with peritoneal superficial endometriosis

“…In our experience, post-operative ovarian stimulation was associated with an increased pregnancy rate after laparoscopic diagnosis and treatment for superficial peritoneal endometriosis related infertility. Our findings were in line with previous studies [20][21][22][23][24][25][26][27] and inconsistent with others [28,29]. However, available data have shown major heterogeneities.…”

“…Considering moderate to severe endometriosis associated infertility, operative laparoscopy could be considered to increase spontaneous pregnancy rate [34], but clear data on post-operative management were missing. Therefore the benefit of superovulation and IUI in moderate to severe endometriosis remains unclear [20].…”

Bladder Endometriosis: A Systematic Review of Pathogenesis, Diagnosis, Treatment, Impact on Fertility, and Risk of Malignant Transformation

“…It cannot be excluded that deep peritoneal lesions may progress under the influence of the higher levels of peripheral sex steroids that typically occur during ovarian hyperstimulation for IVF [147]. It is noteworthy that ureteral obstruction after IVF has been reported in two cases [148,149]. A precise estimation of the magnitude of this risk is lacking, but it is presumably extremely rare, and thus is not sufficient to claim a preventative role of surgery before IVF.…”

Factors associated with a poor prognosis for the IVF-ICSI live birth rate in women with rAFS stage III and IV endometriosis

“…Our patients started directly with the IVF or ICSI cycle, contrary to the study of Van Der Houwen et al (2014b) [31], who showed that patients with rAFS stage III and IV endometriosis should have an intrauterine insemination (IUI) with ovarian stimulation before IVF with a maximum of 3 cycles because it is less expensive and less radical. Nevertheless, most of our patients did not have a patent Fallopian tube, but this was considered in our study because doing so did not waste a lot of time, especially because our cohort of patients was young.…”