Determining the Fertility Benefit of Controlled Ovarian Hyperstimulation With Intrauterine Insemination After Operative Laparoscopy in Patients With Endometriosis

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dc.contributorSistema FMUSP-HC: Faculdade de Medicina da Universidade de São Paulo (FMUSP) e Hospital das Clínicas da FMUSP
dc.contributor.authorGANDHI, Anjalika R.
dc.contributor.authorCARVALHO, Luiz Fernando
dc.contributor.authorNUTTER, Benjamin
dc.contributor.authorFALCONE, Tommaso
dc.date.accessioned2014-04-28T22:05:42Z
dc.date.available2014-04-28T22:05:42Z
dc.date.issued2014
dc.description.abstractStudy Objective: To determine the fertility benefit of controlled ovarian hyperstimulation (COH) and intrauterine insemination (IUI) in surgically treated endometriosis. Design: Retrospective cohort study (Canadian Task Force classification II-2). Setting: Cleveland Clinic Foundation, tertiary care center. Patients: Ninety-six women of reproductive age who underwent operative laparoscopy to treat endometriosis-related infertility (endometriosis stage I/II n = 67; stage III/IV n = 29) from 2001 to 2011 at the Cleveland Clinic Foundation. Interventions: COH via letrozole, clomiphene, or gonadotropins, with or without IUI. Measurements and Main Results: Kaplan-Meier estimations of cumulative pregnancy rates were compared by stage between COH/IUI and spontaneous cycles. Patients with stage I/II endometriosis attempted spontaneous pregnancy for 669 months and 216 COH + IUI cycles, and patients with stage III/IV endometriosis attempted spontaneous pregnancy for 379 months and 74 COH + IUI cycles. Crude pregnancy rates were 45.7% in stage I/II and 40.5% in stage III/IV. Twelve-month cumulative pregnancy rates in stage I/II were 45% for spontaneous attempts and 42% for COH + IUI and in stage III/IV were 20% for spontaneous attempts and 10% for COH + IUI (not significant). Cumulative pregnancy rates for COH/IUI in stage I/II were significantly higher than in stage III/IV. Monthly fecundity rates were 3.81% for stage I/II spontaneous, 4.59% for COH/IUI 3.05% for stage III/IV spontaneous, and 1.68% for COH/IUI (not significant). Conclusions: COH + IUI did not improve pregnancy rates in any stage of endometriosis. In stage III/IV we recommend postoperative in vitro fertilization.
dc.description.indexMEDLINE
dc.identifier.citationJOURNAL OF MINIMALLY INVASIVE GYNECOLOGY, v.21, n.1, p.101-108, 2014
dc.identifier.doi10.1016/j.jmig.2013.07.009
dc.identifier.eissn1553-4669
dc.identifier.issn1553-4650
dc.identifier.urihttps://observatorio.fm.usp.br/handle/OPI/5462
dc.language.isoeng
dc.publisherELSEVIER SCIENCE INC
dc.relation.ispartofJournal of Minimally Invasive Gynecology
dc.rightsrestrictedAccess
dc.rights.holderCopyright ELSEVIER SCIENCE INC
dc.subjectASRM staging system
dc.subjectControlled ovarian hyperstimulation
dc.subjectEndometriosis
dc.subjectIntrauterine insemination
dc.subjectLaparoscopy
dc.subject.otherin-vitro fertilization
dc.subject.othermild endometriosis
dc.subject.otherunexplained infertility
dc.subject.otherwomen
dc.subject.othertherapy
dc.subject.wosObstetrics & Gynecology
dc.titleDetermining the Fertility Benefit of Controlled Ovarian Hyperstimulation With Intrauterine Insemination After Operative Laparoscopy in Patients With Endometriosis
dc.typearticle
dc.type.categoryoriginal article
dc.type.versionpublishedVersion
dspace.entity.typePublication
hcfmusp.affiliation.countryEstados Unidos
hcfmusp.affiliation.countryisous
hcfmusp.author.externalGANDHI, Anjalika R.:Cleveland Clin, Cleveland, OH 44195 USA; Case Western Reserve Univ, Cleveland Clin, Lerner Coll Med, Cleveland, OH 44106 USA
hcfmusp.author.externalNUTTER, Benjamin:Cleveland Clin, Cleveland, OH 44195 USA
hcfmusp.author.externalFALCONE, Tommaso:Cleveland Clin, Cleveland, OH 44195 USA; Case Western Reserve Univ, Cleveland Clin, Lerner Coll Med, Cleveland, OH 44106 USA
hcfmusp.citation.scopus21
hcfmusp.contributor.author-fmusphcLUIZ FERNANDO PINA DE CARVALHO
hcfmusp.description.beginpage101
hcfmusp.description.endpage108
hcfmusp.description.issue1
hcfmusp.description.volume21
hcfmusp.origemWOS
hcfmusp.origem.pubmed23911563
hcfmusp.origem.scopus2-s2.0-84891157556
hcfmusp.origem.wosWOS:000329889200016
hcfmusp.publisher.cityNEW YORK
hcfmusp.publisher.countryUSA
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