Japanese Translation

Assisted reproduction in endometriosis

Intra-uterine insemination

A

Treatment with intra-uterine insemination (IUI) improves fertility in minimal-mild endometriosis: IUI with ovarian stimulation is effective but the role of unstimulated IUI is uncertain (Tummon et al., 1997).

Evidence Level 1b

In vitro fertilisation

B

In vitro fertilisation (IVF) is appropriate treatment especially if tubal function is compromised, if there is also male factor infertility, and/or other treatments have failed.

Evidence Level 2b

A

IVF pregnancy rates are lower in patients with endometriosis than in those with tubal infertility (Barnhart et al., 2002).

Evidence Level 1a

The recommendation above is based on a systematic review but the working group noted that endometriosis does not adversely affect pregnancy rates in some large databases (e.g SART and HFEA) (Templeton et al., 1996).

A

Treatment with a GnRH agonist for 3-6 months before IVF or ICSI should be considered in women with endometriosis as it increases the odds of clinical pregnancy fourfold. However the authors of the Cochrane review stressed that the recommendation is based on only one properly randomised study and called for further research, particularly on the mechanism of action (Sallam et al., 2006).

Evidence Level 1b

B

Risk for recurrence is no reason to withhold IVF therapy after surgery for endometriosis stage III or IV since cumulative endometriosis recurrence rates are not increased after ovarian hyperstimulation for IVF (D´Hooghe et al., 2006).

Evidence Level 2a

A

Laparoscopic ovarian cystectomy in patients with unilateral endometriomas between 3 and 6 cm in diameter before IVF/ICSI can decrease ovarian response without improving cycle outcome (Demirol et al., 2006).

Evidence Level 1b

GPP

Laparoscopic ovarian cystectomy is recommended if an ovarian endometrioma ≥ 4 cm in diameter is present to confirm the diagnosis histologically; reduce the risk of infection; improve access to follicles and possibly improve ovarian response. The woman should be counselled regarding the risks of reduced ovarian function after surgery and the loss of the ovary. The decision should be reconsidered if she has had previous ovarian surgery.

Supporting Documentation