IVF/ICSI outcomes of women with minimal to mild endometriosis associated infertility and unexplained infertility / 대한산부인과학회지

OBJECTIVE: The aim of this study is to assess the IVF/ICSI outcomes of infertile women with minimal to mild endometriosis associated and unexplained infertility. METHOD: We performed a retrospective analysis of 513 (IVF/ICSI) cycles with minimal to mild endometriosis associated infertility, 338 cycles with unexplained infertility, 351 cycles with tubal factor infertility as controls between Jan. 1997 and Apr. 2004. Exclusion criteria for study were: age>36 yrs old, the number of oocytes retrieved 20 mIU/ml, patients with nonobstructive azoospermia, polycystic ovarian syndrome. RESULTS: The incidence of primary infertility was significantly higher in minimal to mild endometriosis (72.3%) and unexplained (68.5%) than tubal factor (31.2%) (p<0.0001). There was no difference in fertilization rate between minimal to mild endometriosis associated infertility and unexplained infertility. But minimal to mild endometriosis associated infertility showed significantly lower fertilization rate and the number of total embryos than tubal factor infertility (62.3+/-21.2% vs. 68.8+/-17.6% (p<0.0001), 8.38+/-5.0 vs. 9.81+/-5.2 (p<0.0001)). But the number of good quality embryos was similar. Clinical pregnancy rates of minimal to mild endometriosis associated, unexplained, and tubal factor infertility was 32%, 35.8%, 39.9% and implantation rates was 13.5+/-23.3, 14.3+/-23.6, 16.1+/-23.5, respectively. CONCLUSION: The IVF/ICSI outcomes of minimal to mild endometriosis associated infertility is comparable to those of unexplained infertility with respect to clinical pregnancy rates, implantation rates, and live birth rates. And we suggest that IVF should be considered earlier in patients with minimal to mild endometriosis associated and unexplained infertility because of significantly decreased fertilization rates and longer duration of infertility.

The length of the follicular phase influences normal fertilization rates in assisted reproduction.

Factors affecting normal fertilization rates (NFR) were studied in 1,776 IVF patients having 3383 treatments during 1990-1992. Interestingly, the longer the follicular phase (LFP) the higher the fertilization rate: LFP <12, 12, 13, and >13 days, NFR 49.6%, 53.8, 53.9 and 56.1% respectively. Higher fertilization rates were also related to normal semen analysis results, older females, the use of frozen husband and donor sperm, the diagnosis of tubal disease and the use of ovarian stimulation protocols other than clomiphene citrate plus human menopausal gonadotrophin.