The efficacy of assisted reproductive technology in patients with endometriosis

Cilj istraživanja: Cilj je ovog istraživanje utvrditi uspješnost medicinski potpomognute oplodnje u pacijentica s endometriozom. Drugi cilj je utvrditi medijan prikupljenih oocita i dobivenih zametaka, medijan ukupne doze stimulirajućih hormon te otkriti utjecaj dobi pacijentica i serumske razine FSH i AMH na stopu implantacije. Materijali i metode: Ovo retrospektivno istraživanje provedeno je u Klinici za ženske bolesti i porode KBC-a Split u razdoblju od 1. siječnja 2016. do 1. srpnja 2018. godine. Podatci su prikupljeni iz povijesti bolesti pacijentica te iz baze podataka MPO Zavoda za ginekološku endokrinologiju i humanu reprodukciju. U istraživanje je uključeno 28 pacijentica u dobi od 25 do 47 godina. Prikupljeni su podatci o vrsti protokola i gonadotropinima koji su korišteni u liječenju, jajnim stanicama dobivenim aspiracijom, zamecima, provedenim embriotransferima, HCG-u te serumskim razinama FSH i AMH. Pacijentice s dijagnozom endometrioze koje su se podvrgnule MPO uključene su u istraživanje. Kriteriji isključenja bili su hiperprolaktinemija i bolesti štitnjače. Rezultati: Ukupna stopa implantacije IVF/ICSI po ET-u, FET po ET-u i AIH-a u pacijentica s endometriozom iznosila je 19,6%, dok je u ostalih neplodnih pacijentica iznosila 30,1%. Stopa implantacije IVF/ICSI metode po ET-u u pacijentica s endometriozom iznosi 18,8%, a u neplodnih pacijentica bez endometrioze iznosi 37,5% (95% CI: 34-41,2%). Analizom 88 protokola MPO provedenih u 28 pacijentica s endometriozom dobiveni medijan jajnih stanica iznosi 2 (1-6; 0-20), medijan zametaka 2 (0-2; 0-5), medijan ampula gonadotropina 13,5 (7-23; 0-60) te medijan ampula agonista/antagonista GnRH 5 (0-7; 0-28). Broj prikupljenih jajnih stanica (P=0,215), danih ampula gonadotropina (P=0,828) i danih ampula agonista/antagonista GnRH (P=0,312) ne korelira sa stopom implantacije. Medijan broja zametaka za 1 je veći kod pacijentica s uspješnom implantacijom (P=0,033). Dob (P=0,521), serumska razini FSH (P=0,888) i AMH (P=0.972) ne utječe na stopu implantacije. Zaključci: IVF/ICSI metoda MPO se najčešće koristi u liječenju neplodnosti pacijentica s endometriozom. Pacijentice s dijagnozom endometrioze koje su pristupile IVF/ICSI metodi imaju smanjenu stopu implantacije po embriotransferu u usporedbi s ostalim neplodnim pacijenticama koje su se podvrgnule ovoj istoj metodi MPO. Dokazana je smanjena učinkovitost svih metoda MPO u pacijentica s endometriozom.Objectives: This thesis aims to evaluate the implantation rate in patients with endometriosis. Furthermore, its goal is to establish the median of retrived oocytes and embryos, median of total dosage of stimulating hormones as well as to discover the impact of age and serum levels of FSH and AMH on implantation rate. Patients and methods: This retrospective study was carried out at the Department of Gynecology and Obstretrics in University Hospital of Split from January 1st 2016 till July 1st 2018. The data on the protocol type and gonadotropins used in the treatment, number of retrived oocytes, embryos and embriotransfers, serum levels of HCG, FSH and AMH were collected from patients' medical histories and from an ART database at the Institute for Gynecological Endocrinology and Human Reproduction. A total of 28 women, aged 25-47, participated in the study. Patients with endometriosis undergoing assisted reproductive tehnologies were included, while patients with thyroid disease and hyperprolactinemia were excluded from the study. Results: Total implantation rate of IVF/ICSI per ET, FET per ET and AIH in patients with endometriosis was 19.6%, while the implantation rate in infertile patients without endometriosis was 30.1%. The implantation rate of IVF/ICSI method per embriotransfer in patients with endometriosis was 18.8%, while the implantation rate in infertile women without endometriosis was 37.5%. 88 protocols in 28 patients were analysed. Median of retrived oocytes was 2 (1-6; 0-20), median of embryos was 2 (0-2; 0-5), median of gonadotropin ampules was 13.5 (7-23; 0-60) and the median of agonist/antagonist GnRH ampules was 5 (0-7; 0-28). The number of retrived oocytes (P=0.215), ampules of gonadotropin (P=0.828) and ampules of agonist/antagonist GnRH did not have an impact on implantation rate. The number of embryos did have an impact on implantation rate (P=0.033). Age (P=0.521), serum level of FSH (P=0.888) and AMH (P=0.972) did not have an impact on implantation rate. Conclusions: IVF/ICSI is the first choice method of ART in threatening infertility in women with endometriosis. Patients with endometriosis undergoing IVF/ICSI have a lower implantation rate per embriotransfer than other infertile women. The efficacy of ART is lower in women with endometriosis