Research question

The major causes of IVF failure in women with endometriosis have been attributed to decreased ovarian reserve, low embryo quality and impaired receptivity of the endometrium. Dienogest (DNG) has anti-inflammatory and anti-angiogenic activity and so may theoretically improve IVF outcomes in women with endometriosis. This study aimed to evaluate the administration of DNG before IVF in women with endometriosis who had previously failed one IVF cycle.

Methods

This study was based on the retrospective analysis of a prospectively collected database, including 151 women who had failed a previous IVF cycle and all subsequent embryo transfers and had an imaging diagnosis of endometriosis. Patients either directly underwent IVF without receiving hormonal treatment or received 3 months of treatment with DNG (2 mg/daily) before IVF.

Results

Eighty-eight (58.3%) patients underwent IVF without previous hormonal treatment, and 63 (41.7%) received pretreatment with DNG. The cumulative implantation, clinical pregnancy and live birth rates were significantly higher in the DNG-treated group (39.7%, 33.3% and 28.6%) than in the non-treated group (23.9%, 18.2% and 14.8%; P = 0.049, 0.037 and 0.043, respectively). The largest diameter of endometriomas significantly decreased after DNG pretreatment (P < 0.001). The use of DNG increased significantly the number of oocytes retrieved (P = 0.031), two-pronuclear embryos (P = 0.039) and blastocysts (P = 0.005) in women with endometriomas of diameter ≥4 cm.

Conclusions

This study suggest that in patients with endometriosis, IVF outcomes can be improved by pretreatment with DNG. In particular, the use of DNG allows for better oocyte retrieval and blastocysts in patients with large endometriomas.

中文翻译：

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在先前失败的周期后接受试管婴儿的子宫内膜异位症女性用地诺孕素预处理。

研究问题

子宫内膜异位症女性试管婴儿失败的主要原因是卵巢储备减少、胚胎质量低下和子宫内膜容受性受损。Dienogest (DNG) 具有抗炎和抗血管生成活性，因此理论上可以改善子宫内膜异位症女性的 IVF 结果。本研究旨在评估在试管婴儿之前对曾经失败过一次试管婴儿的子宫内膜异位症女性进行试管婴儿前使用 DNG 的情况。

方法

本研究基于对前瞻性收集的数据库的回顾性分析，其中包括 151 名前一次试管婴儿周期和所有后续胚胎移植均失败且影像学诊断为子宫内膜异位症的女性。患者要么直接接受试管婴儿而不接受激素治疗，要么在试管婴儿前接受 3 个月的 DNG（每天 2 毫克）治疗。

结果

88 名 (58.3%) 患者在没有接受过激素治疗的情况下接受了 IVF，63 名 (41.7%) 接受了 DNG 的预处理。DNG 治疗组的累积着床率、临床妊娠率和活产率（39.7%、33.3% 和 28.6%）显着高于未治疗组（23.9%、18.2% 和 14.8%；P  = 0.049， 0.037 和 0.043）。DNG预处理后子宫内膜异位症的最大直径显着减小（P  < 0.001）。DNG 的使用显着增加 了子宫内膜异位瘤直径 ≥ 4 cm 女性的卵母细胞数量 ( P  = 0.031)、双原核胚胎 ( P  = 0.039) 和囊胚 ( P = 0.005) 的数量。

结论

这项研究表明，在子宫内膜异位症患者中，通过使用 DNG 进行预处理可以改善 IVF 结果。特别是，使用 DNG 可以更好地提取大子宫内膜异位症患者的卵母细胞和囊胚。