Gamete intra-Fallopian transfer or intrauterine insemination after controlled ovarian hyperstimulation for treatment of infertility due to endometriosis

Abstract

We compared the effectiveness of gamete intra-Fallopian transfer (GIFT) and intrauterine insemination (IUI) after controlled ovarian hyperstimulation (COH) in the treatment of infertility due to endometriosis. This was a retrospective study carried out at a tertiary teaching medical center. A total of 127 consecutive patients with endometriosis were treated with GIFT or IUI after COH between June 1990 and December 1998. Patients were divided into two groups. Group 1 (n = 97) included patients with stages 1 and 2 endometriosis, and group 2 (n = 30) included patients with stages 3 and 4 endometriosis. Laparoscopic conservative surgery for endometriosis was performed prior to IUI for patients in both group 1 and group 2. In group 1, 55 patients underwent 95 cycles of IUI after COH and 42 patients underwent 57 cycles of GIFT. In group 2, 14 patients underwent 16 cycles of IUI after COH, while 16 patients underwent 22 cycles of GIFT. The stimulation protocol for both GIFT and IUI was mid-luteal pituitary down-regulation with a gonadotropin releasing hormone agonist (GnRH-a) followed by gonadotropins. In group 1, the pregnancy rates (GIFT = 50.9%, IUI = 29.4%) and the delivery rates (GIFT = 28.1%, IUI = 14.7%) per cycle were significantly higher in GIFT compared to IUI (p = 0.009 and p = 0.05, respectively). There was no significant differences in the pregnancy rate (GIFT 69%, IUI 50.9%, respectively) or the delivery rate (GIFT 38.1%, IUI 25.5%) per patient. In group 2, there was no significant difference in the pregnancy rate (GIFT 54.5%, IUI 31.3%) or the delivery rate (GIFT 40.9%, IUI 12.5%) per cycle, but the difference in the pregnancy rate (GIFT 75%, IUI 35.7%) and the delivery rate (GIFT 56.3%, IUI 14.3%) per patient was significantly higher in GIFT compared to IUI (p = 0.04 and p = 0.02, respectively). We conclude that, when the same stimulation protocol is used in the early stages of endometriosis, a few cycles of IUI can achieve similar results to GIFT, and therefore should be used first. In advanced stages of endometriosis GIFT appears to be more effective.

Unilateral versus bilateral adnexal disease in stage III and stage IV endometriosis does not affect pregnancy outcome after operative laparoscopy

“…In our study, approximately one-third of patients with advanced endometriosis were able to conceive within 2 years after operative laparoscopy as a result of spontaneous trials and/or IUI+COH. Other reports suggested similar results when IUI+COH was used after operative laparoscopy for early and advanced endometriosis [25][26][27]. Therefore, it could be offered for two to three cycles either immediately following surgery or after three to four failed cycles of spontaneous trials.…”

Impact of endometriosis and its staging on assisted reproduction outcome: systematic review and meta-analysis

“…Figures , , S3 and S4 report the results of the 29 individual studies included in the quantitative review that had compared Stage‐III/IV vs Stage‐I/II endometriosis.…”

“…A total of 176 records were completely assessed for eligibility, of which 84 studies were excluded with reasons: 70 studies did not compare endometriosis vs control or Stage III/IV vs Stage I/II endometriosis undergoing ART; eight studies did not report any of the evaluated outcomes; five studies included participants reported in newer or larger studies; and one study included only women who achieved pregnancy. We included 92 studies in this review, of which 78 studies were included in the quantitative meta‐analysis: 21 for both comparisons; 49 only for the comparison ‘endometriosis vs control’; and eight only for the comparison ‘Stage III/IV vs Stage I/II endometriosis’. Fourteen studies were included only in the qualitative review: two studies for both comparisons…”

Comparison of urinary and recombinant human chorionic gonadotropin during ovulation induction in intrauterine insemination cycles: a prospective randomized clinical trial

“…It was previously shown that the addition of a GnRH agonist down-regulation to the stimulation protocol of IUI improves the outcome (11). Using a GnRH agonist and hMG protocol, a previous report from our unit has shown that COH-IUI can be as effective as gamete intrafallopian transfer procedures in patients with early stages of endometriosis (10).…”

“…The use of GnRH agonist and, more recently, GnRH antagonist is an essential component of our stimulation protocol (10). It was previously shown that the addition of a GnRH agonist down-regulation to the stimulation protocol of IUI improves the outcome (11).…”