In vitro fertilization outcome in patients with endometriosis

UVOD: Neplodnost se definira kao bolest reproduktivnog sustava čije je glavno obilježje nemogućnost ostvarivanja kliničke trudnoće uz redovne, nezaštićene spolne odnose tijekom najmanje 12 mjeseci. Endometrioza je bolest u kojoj je jedan od vodećih simptoma neplodnost oboljele žene. Procjenjuje se kako od endometrioze boluje 10 – 15 % žena reproduktivne dobi. Postavljanje dijagnoze endometrioze i liječenje iste su zahtjevni, a posebno mjesto zauzima liječenje neplodnosti metodama medicinski pomognute oplodnje. ----- CILJEVI RADA: Dokazati da endometrioza ima štetan utjecaj na plodnost i štetan učinak na ishod in vitro fertilizacije. ----- ISPITANICI I METODE: Provedeno je slučaj – kontrola istraživanje na 34 neplodna para koji su pristupili postupku in vitro fertilizacije na Klinici za ženske bolesti i porode KBC Zagreb u razdoblju od 2015. – 2018. godine. Podaci su prikupljeni iz arhive Zavoda te iz dostupne medicinske dokumentacije. Od 34 neplodne žene, njih 17 je imalo patohistološki potvrđenu dijagnozu endometrioze, a 17 žena u kontrolnoj skupini imalo je u podlozi neplodnost drugog uzroka. Uparivanje žena izvršeno je na temelju podudarnosti u dobi pri postupku, BMI-u i koncentraciji FSH mjerenog drugi dan menstruacijskog ciklusa. ----- REZULTATI: U ispitanica s endometriozom prosječna vrijednost koncentracije AMH iznosila je 12 pmol/L što se može tumačiti kao dokaz smanjene plodnosti u žena oboljelih od endometrioze, a na temelju provedenih hi – kvadrat testova zaključuje se kako ne postoji statistički značajna razlika u postizanju trudnoće uz in vitro fertilizaciju između žena s endometriozom i kontrolne skupine (Χ2 =0,524, df=2 , p=0,724), kao niti u rađanju živorođene terminske djece (Χ2 =0,067, df=2 , p=0,714). ----- ZAKLJUČAK: Endometrioza ima štetan učinak na plodnost žene, ali endometrioza kao bolest nema štetan učinak na ishod izvantjelesne oplodnje.BACKGROUND: Infertility is defined as a disease of the reproductive system defined by the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse. Endometriosis is a disease with infertility as one of the leading symptoms. It is estimated that 10 – 15 % of women of reproductive age suffer from it. Diagnosing and treatment of endometriosis are challenging, but the special emphasis is placed on the treatment of endometriosis related infertility using assisted reproductive technology (ART). ----- AIM: To determine whether endometriosis is related to lower fertility rates and lower outcomes of IVF procedures. ----- SUBJECTS AND METHODS: Case – control study was conducted on 34 infertile couples that underwent IVF procedures at The Division of Human Reproduction at the Department of Gynaecology and Obstetrics at University Hospital Centre Zagreb. Data was collected from the hospital archive. Out of 34 infertile women, 17 have been diagnosed with endometriosis based on pathohistological findings, and 17 of them had another underlying causes of infertility. Patients were matched into pairs taking into account their age, BMI and FSH concentration measured on the second day of the menstrual cycle. ----- RESULTS: Average AMH concentration in patients with endometriosis was 12 pmol/L and this result can be interpreted as an evidence of lower fertility rates among this group of women. Chi – quadrate tests that were carried out showed no statistically significant difference in achieving pregnancy in both groups (Χ2 =0,524, df=2 , p=0,724), as well as in giving birth to a live term – born children (Χ2 =0,067, df=2 , p=0,714). ----- CONCLUSION: Endometriosis has a negative outcome on fertility rates, but does not affect the outcomes of IVF procedures