The impact of IVF on deep invasive endometriosis

Abstract

Objective Ovarian hyper-stimulation during IVF is associated with a significant raise in serum estrogens and one may expect detrimental effects on estrogen-dependent diseases such as endometriosis. However, available evidence from large case series of affected women performing IVF is generally reassuring with the possible exception of women carrying deep invasive lesions. On this basis we deemed important investigating more in depth whether women with deep invasive endometriosis could be a subgroup at higher risk of recurrence or disease progression during IVF. Study design Women with endometriosis who underwent IVF and who had a second evaluation after 3–6 months from a failed cycle were retrospectively reviewed. The main inclusion criteria were the presence of deep invasive endometriosis and/or a history of surgery for this form of the disease. The primary aim of the study was to determine the frequency of endometriosis-related complications in the interval between the two evaluations. Secondary aims were pain symptoms and lesion size modifications. Results Eighty-four women were ultimately selected: baseline ultrasound documented deep invasive lesions in 60 of them. One case of possible endometriosis-related complication was recorded, corresponding to a rate of 1.2% (95%: 0.05%–5.5%) for the whole cohort and 1.7% (95%CI: 0.08–7.6%) for the subgroup of women with ultrasound detected lesions. This rate appears similar to the reported frequency of endometriosis progression in women not receiving IVF. No significant modifications in pain symptoms or lesions size occurred. Conclusions Women with deep invasive endometriosis who underwent IVF do not seem to be exposed to a substantially increased risk of recurrence/disease progression. Larger evidence from independent groups is however required for a definitive conclusion.

Conservative Management of Rectovaginal Deep Endometriosis: Shaving Should Be Considered as the Primary Surgical Approach in a High Majority of Cases

“…Starting IVF with a DE nodule left in place is highly questionable, and especially in women suffering from severe chronic pelvic pain or serious dysmenorrhea. Berlanda et al clearly showed that IVF procedure did not have positive impact on pain symptoms in a retrospective series of 84 patients with DE undergoing IVF cycles [ 44 ]. This strongly suggests that excision surgery should be discussed with infertile women suffering pain symptoms associated to DE to improve their quality of life, as statistical improvement in both sexual- and health-related quality of life is observed after surgery [ 45 ].…”

“…The surgical procedure of rectal shaving in excision of DE nodules was firstly described in 1991 by Donnez [ 48 ] and Reich [ 49 ]. These studies were followed by many others from the same team between 1997 and 2013, with the biggest series so far about 3298 cases [ 15 , 35 , 44 , 50 , 51 , 52 ].…”

First-line in vitro fertilization or surgery for infertile women with bowel endometriosis?

“…Nevertheless, it is unclear if a bowel lumen stenosis R50% was systematically ruled out in these women before proceeding with assisted reproductive technologies (ART). In fact, the incidence of severe complications specifically due to the progression of infiltrating colorectal lesions in women without preexisting subocclusion seems limited, despite the temporary hyperestrogenism typical of IVF (3).…”