SOC 280 Assisted Reproductive Technologies
SOC 280 Assisted Reproductive Technologies
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The impact of endometriosis on fertility and proposed mechanisms of this phenomenon have been addressed elsewhere in this paper. The assisted reproductive technologies and, more specifically, in vitro fertilization (IVF) represent the most successful means of achieving conception in endometriosis patients struggling with infertility. This approach bypasses anatomic distortion, potential compromise in tubal function, and aberrations in the peritoneal environment associated with this disease. In this paper, we shall explore the impact of endometriosis on IVF cycle outcomes as well as whether surgical or medical management of endometriosis per se can impact success rates.
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SOC 280 Assisted Reproductive Technologies
2. The Impact of Endometriosis on IVF Outcome
The issue of whether the diagnosis of endometriosis has a negative impact on the outcome of IVF has not been resolved. Although several early studies suggested poorer outcomes in comparison to controls, other showed no significant differences [1]. A meta-analysis performed by Barnhart et al., which included only clinical trials published from 1983–98, calculated that the number of oocytes obtained as well as fertilization, implantation, and pregnancy rates was lower after IVF in patients with endometriosis than in controls with tubal factor infertility [2]. It is important to note that pregnancy rates in both groups were extremely low (12.7% versus 18.1%) and do not reflect the significantly improved outcomes which are typically achieved in current practice. A more contemporary Norwegian retrospective analysis from a single center reported virtually identical live birth rates after IVF for patients with endometriosis versus tubal infertility (66.0% versus 66.7%) [3]. Implantation rates were also similar between the groups. Barcelos et al. more recently noted no differences in the percentage of meiotic abnormalities in in vitro matured oocytes from endometriosis or control patients after ovarian stimulation [4].
The 2012 Clinic Summary Report of the Society for Assisted Reproductive Technology reflects no real differences in implantation or pregnancy rates when comparing the subgroup of patients with endometriosis to the aggregate of patients with all diagnoses undergoing IVF in the United States [5] (Table 1). It is important to note that the database does not reflect disease stage, past therapy, or presence of ovarian endometriomas. Also of note is the fact that this summary reports that only 3% of the cycles performed in 2012 in the United States were associated with a primary diagnosis of endometriosis which is clearly an underestimate. This discrepancy can be attributed to the decreasing role of diagnostic laparoscopy as part of the infertility evaluation leading to these patients being classified with a diagnosis of either “unexplained infertility” or under some other primary diagnosis that may have been considered to have a greater impact on fertility.
SOC 280 Assisted Reproductive Technologies Essay
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