Surgery
may improve endometriosis-related sub-fertility
IVF can be perceived as
the last hope in achieving pregnancy, yet researchers
at Stanford University have looked at patients with
previous IVF failures who conceived following laparoscopic
treatment for endometriosis.
Out of 29 patients with prior IVF failures, 22 (76%)
conceived following laparoscopic treatment of endometriosis,
including non-IVF pregnancies and seven IVF pregnancies
[1].
"In some cases IVF can still be successful despite
the presence of untreated endometriosis," said
Camran Nezhat MD, president of the Society of Laparoscopic
Surgeons and a fertility specialist at Stanford University
Medical Center who helped lead the study. "However,
this research shows that one should not bypass the pelvic
area, instead, the option of a thorough laparoscopic
evaluation and surgical technique may give the patient
a greater rate of success."
Whereas the number of women enrolled in this study is
relatively small, the authors conclude that complete
and thorough microsurgical eradication of endometriosis
allows many patients to conceive without further IVF
therapy and may help optimize success for those who
require subsequent IVF cycles.
A previous study in 1997, by Marcoux et al,
showed that when endometrioc implants in women with
minimal-mild endometriosis were removed there was a
significantly higher monthly fecundity rate in the treated
compared to the control group [2].
According to Kutluk Oktay MD,Head of The Program for
Fertility Preservation Research at Weill Medical College
of Cornell University:"Recent studies have showed
that endometriosis may be associated with alteration
in the genes that play role in embryo implantation.
While performing laparoscopy on women who failed to
get pregnant on IVF is different than the current practice,
it is only by challenging the "norm" that
science and medicine can progress."
Part of the reduction in pregnancy rates to begin with
may be due to the inability of the fertilized egg to
properly implant into the lining tissue when a woman
has endometriosis. Several studies have examined the
association of endometriosis and implantation failure
on a molecular level. These basic studies suggest that
endometriosis may be involved in the deregulation of
select genes that play critical roles in the process
of implantation.Therefore, in addition to decreasing
inflammation in the pelvis and associated toxicity to
embryos and gametes, surgical treatment of disease may
result in enhanced uterine receptivity.
According to Dr Nezhat there is hope for many couples
who have experienced failed IVF: "Whereas women
are commonly in their mid-30s or older when they seek
infertility therapy. This, combined with the risks of
undergoing a surgical procedure, often leads patients
who disregard other methods and go straight to IVF without
thorough evaluation or therapy of potential endometriosis.
Furthermore, when initial IVF cycles fail, patients
and physicians tend to choose additional IVF treatment
and some may even elect oocyte donation after multiple
failures. Many couples and physicians believe that since
the ultimate therapy, IVF, failed to result in a pregnancy,
further infertility investigation and treatment are
likely to be futile".
"This research is important for couples who have
become anxious after trying to achieve pregnancy after
many years. I hope that this study will influence the
methods of treatment so we can achieve much more success
in this area of medicine", concludes Dr. Nezhat.
See also www.nezhat.org
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