Ovarian
hyperstimulation link to endometriosis recurrence
Ovarian hyperstimulation
(OH), and the associated elevation in serum oestradiol,
may not be a major risk factor for endometriosis recurrence,
say Belgian researchers.
The researchers set out to test the hypothesis that
the cumulative endometriosis recurrence rate (CERR)
after fertility surgery for endometriosis stage III
or IV is increased in women exposed to very high E(2)
levels during ovarian hyperstimulation (OH) for IVF
when compared with women exposed to less high E(2) levels
during OH for intrauterine insemination (IUI).
In a retrospective study, the team assessed the recurrence
of endometriosis in 67 women who underwent pelvic reconstructive
surgery for stage III or IV disease before attempting
IVF, intrauterine insemination, or both procedures in
different cycles.
Importantly, women were exposed to higher oestradiol
levels during OH for IVF than they were during IUI,
according to Professor Thomas D'Hooghe (Leuven University
Fertility Center) and colleagues.
They found that, 21 months after the start of OH, the
cumulative rate of endometriosis recurrence was just
sven percent in women who only underwent IVF, compared
with 43 percent in those who attempted both IVF and
IUI, and 70 percent in the IUI-only participants.
Attempting to explain these results, the team says:
"It is possible that OH for IVF does not have an
adverse effect on the recurrence of endometriosis. However,
it is also possible that women with blocked tubes, due
to endometriotic adhesions, who are treated with IVF
are less likely to develop new endometriotic lesions
than patients with open fallopian tubes who are treated
with IUI and who are exposed to retrograde menstruation
every month."
|
