ICSI Outcomes for Laparoscopic Intervention of Endometriosis

Laparoscopic removal of endometriomas can adversely affect fertility treatments in women with endometriosis.

Key Points

Highlights:

• This study looked at the differences in ICSI cycles between patients
  • who used laparoscopic surgery to treat ovarian endometriomas,
  • who had their peritoneal endometriosis removed,  
  • with untreated endometriosis, and   
  • Infertility patients not related to endometriosis (tubal factor related infertility).
• The outcome of IVF/ICSI cycles found to be related to the number of transferred embryos, duration of infertility, and the number of total oocytes retrieved (reflecting ovarian reserve), and laparoscopic cystectomy of endometriomas may worsen IVF/ICSI outcomes by decreasing ovarian reserve and quality of oocyte-embryo.

Importance:

• Inflammatory mediators of peritoneal endometriosis may compromise fertilization and implantation.
• Fertilization, implantation, and pregnancy rates were all decreased in IVF cycles for endometriosis-related infertility.
• The stage of endometriosis and infertility is not correlated, and the specific impact of endometrioma alone or surgical treatment of endometriosis on IVF/ICSI outcomes should be clarified.

What’s done here?

• A total of 150 patients collectively underwent 257 ICSI cycles, and when divided according to a condition:
• Before the IVF cycle, all participants were subject to a pelvic exam, transvaginal ultrasonography, hysterosalpingography, basal antral follicle count, and hormonal tests. Their partner’s sperm was also analyzed.
• Protocols were tailored for the individual patient depending on a variety of factors (age, basal antral follicle count, FSH level, BMI, and E2 levels).
• Oocyte retrieval occurred 36 hours after hCG administration and the embryo was transferred 2-3 days after oocyte retrieval. Two weeks later beta-hCG measured, ultrasonography done to check the pregnancy. 
• The primary measurements were pregnancies and live birth rates;  secondary measurements are the length of ovarian stimulation, the amount of Gonadotropin consumed, the amount of retrieved oocytes, fertilization, and rate of embryo cleavage.

Key results:

• There was no difference between the rate of clinical pregnancies and live births for the respective groups.
• The factors that affected live birth rates were the number of embryos transferred, the duration of infertility, and basal antral follicle count. In fact, laparoscopic removal of endometriomas could reduce the number and quality of oocytes and embryos, which adversely impacts IVF/ICSI outcomes.
• For the endometrioma cystectomy group basal reserve, average serum E2 on the day of the hCG injection, dominant follicle number, retrieval total, MII oocytes, fertilization and embryo cleavage rates were lower.
• Average starting and total gonadotropin consumption were higher for the endometrioma cystectomy group.

Limitations of the study:

• This study was conducted in one region over the course of a decade.
• There were many groups excluded from the study including but not limited to women who have previously had a laparotomy to treat endometrioma and women with reoccurring endometriomas.

Lay Summary

Women with endometriosis can have trouble conceiving and often turn to fertility treatments for help. Guler et al. recently published a paper in Systems Biology in Reproductive Medicine titled “The Impact of laparoscopic surgery of peritoneal endometriosis and endometrioma on the outcome of ICSI cycles” that examined the effects laparoscopic surgery has on fertility treatments, specifically ICSI (intracytoplasmic sperm injection), in individuals with endometriosis. Laparoscopic surgery removes problematic ovarian endometriomas and peritoneal endometriosis.

The results of ICSI after the two aforementioned laparoscopic removals, of ovarian endometriomas and peritoneal endometriosis, were compared to ICSI outcomes in patients with untreated endometriomas and in patients with tubal factors without endometriosis. The patients with the tubal factor infertility were the control group in this study. The study consisted of 150 patients undergoing 257 cycles of ICSI treatment. The breakdown of these numbers is as follows: 48 patients with less severe endometriosis collectively underwent 91 cycles, 25 patients whose endometriosis was removed underwent 57 cycles, 53 endometriosis patients were not operated on and underwent 65 cycles, and 24 patients had a tubal factor and underwent 44 cycles.

Results showed that for the endometrioma cystectomy group basal reserve, average serum E2 on the day of the hCG injection, dominant follicle number, retrieval total, MII oocytes, fertilization and embryo cleavage rates were lower. On the other hand, average starting and total gonadotropin consumption were higher for this same group. As far as live birth and clinical pregnancy rates are concerned, all the tested groups had similar results. The factors that actually made a difference in the live birth and clinical pregnancy rates were the number of embryos transferred, how long the patient was infertile, and basal antral follicle count. Ultimately the results showed that laparoscopic removal of endometriomas could adversely affect the number and quality of oocytes and embryos, both of which are important factors for IVF/ICSI.

Research Source: https://www.ncbi.nlm.nih.gov/pubmed/28609124