La cirugÝa pÚlvica como un marcador predictivo de la respuesta folicular a los inductores de ovulación / Pelvic surgery as a predictive marker of the follicular response to ovulation inducers

RESUMO

OBJECTIVE: Comparing the follicular response in a group of patients with previous pelvic surgery submitted to in vitro fertilization. MATERIAL AND METHODS: Patients who were going to be submitted to controlled ovarian stimulation and in vitro fertilization were included. Two groups were formed one with those patients who had had a previous pelvic operation and the other with those patients who had not. The characteristics which were analyzed included age, weight, body mass index, FSH, LH and estradiol levels, as well as total ova numbers, grade of embryonic maturity, and number of transferred embryos. RESULTS: Ninety nine patients were studied 46 had been submitted to pelvic surgery and 53 had not. Due to the design of the study there were no differences regarding age, weight, size and body mass index; the evaluation of the ovarian reserve was similar in both groups. However, the group of patients previously submitted to pelvic surgery presented a lower quantity of total ova (p = 0.004), less mature ova (p = 0.008) with a significantly lower pregnancy rate. CONCLUSIONS: Surgical procedures, combined with adherence processes, probably have a direct incidence on the characteristics of the perifollicular environment which interfere with adequate development of the ovum. All these can be observed in a decrease of fertilization processes and embryonic development, regardless of the expression of the adequate biochemical markers of the ovarian reserve. Our research shows that the group under study presents a decrease in follicular response affecting the quality of the ovum-embryo expressed in the pregnancy rate.