Top

BMC Pregnancy and Childbirth

Published in:

Open Access 01-12-2021 | ICSI | Research article

Role of suppression of endometriosis with progestins before IVF-ET: a non-inferiority randomized controlled trial

Authors: Eissa Khalifa, Hashem Mohammad, Ameer Abdullah, Mazen Abdel-Rasheed, Mohammed Khairy, Mahmoud Hosni

Published in: BMC Pregnancy and Childbirth | Issue 1/2021

Abstract

Background

Endometriosis affects the responsiveness to ovarian stimulation. This study aimed to assess the role of Dienogest pretreatment for endometriosis suppression as compared to Gonadotropin-releasing hormone agonist (GnRHa) in patients with endometriosis pursuing IVF treatment.

Methods

In this randomized controlled trial, 134 women with endometriosis-related infertility were randomly allocated to group A (n = 67) who had monthly depot GnRHa for 3 months before ovarian stimulation in IVF treatment (Ultra-long protocol), and Group B (n = 67) who had daily oral Dienogest 2 mg/d for 3 months before starting standard long protocol for IVF. The primary outcome measure was the number of oocytes retrieved. The secondary outcome measures included the number of mature oocytes, fertilization rate, quality of life assessed by FertiQoL scores, cost of treatment, and pregnancy outcomes.

Results

Although there was no statistically significant difference between both groups regarding ovarian stimulation, response parameters, and pregnancy outcomes, the Dienogest group had a lower cost of treatment (2773 vs. 3664 EGP, P < 0.001), lower side effects (29.9% vs. 59.7%, P < 0.001), higher FertiQoL treatment scores (33.2 vs. 25.1, P < 0.001) and higher tolerability scores (14.1 vs. 9.4, P < 0.001 < 0.001).

Conclusion

Our study indicates that Dienogest is a suitable and safe substitute for GnRHa pretreatment in endometriosis patients.

Trial registration

NCT04500743 “Retrospectively registered on August 5, 2020”.

Harb H, Gallos I, Chu J, Harb M, Coomarasamy A. The effect of endometriosis on in vitro fertilisation outcome: a systematic review and meta-analysis. BJOG Int J Obstet Gynaecol. 2013;120(11):1308–20. https://doi.org/10.1111/1471-0528.12366.CrossRef

Sanchez AM, Vanni VS, Bartiromo L, Papaleo E, Zilberberg E, Candiani M, et al. Is the oocyte quality affected by endometriosis? A review of the literature. J Ovarian Res. 2017;10:1–11.CrossRef

Fan Y-Y, Chen H-Y, Chen W, Liu Y-N, Fu Y, Wang L-N. Expression of inflammatory cytokines in serum and peritoneal fluid from patients with different stages of endometriosis. Gynecol Endocrinol. 2018;34(6):507–12. https://doi.org/10.1080/09513590.2017.1409717.CrossRefPubMed

Xu B, Guo N, Zhang X, Shi W, Tong X, Iqbal F, et al. Oocyte quality is decreased in women with minimal or mild endometriosis. Sci Rep. 2015;5(1):10779. https://doi.org/10.1038/srep10779.CrossRefPubMedPubMedCentral

Brown J, Pan A, Hart RJ. Gonadotrophin-releasing hormone analogues for pain associated with endometriosis. Cochrane Database Syst Rev. 2010;2010(12):CD008475. https://doi.org/10.1002/14651858.CD008475.pub2.

Della Corte L, Barra F, Mercorio A, Evangelisti G, Rapisarda AMC, Ferrero S, et al. Tolerability considerations for gonadotropin-releasing hormone analogues for endometriosis. Expert Opin Drug Metab Toxicol. 2020;16(9):759–68. https://doi.org/10.1080/17425255.2020.1789591.CrossRefPubMed

Surrey ES, Silverberg KM, Surrey MW, Schoolcraft WB. Effect of prolonged gonadotropin-releasing hormone agonist therapy on the outcome of in vitro fertilization-embryo transfer in patients with endometriosis. Fertil Steril. 2002;78(4):699–704. https://doi.org/10.1016/S0015-0282(02)03373-3.CrossRefPubMed

Cao X, Chang H, Xu J, Zheng Y, Xiang Y, Xiao B, et al. The effectiveness of different down-regulating protocols on in vitro fertilization-embryo transfer in endometriosis: a meta-analysis. Reprod Biol Endocrinol. 2020;18:1–12.CrossRef

Georgiou EX, Melo P, Baker PE, Sallam HN, Arici A, Garcia-Velasco JA, et al. Long-term GnRH agonist therapy before in vitro fertilisation (IVF) for improving fertility outcomes in women with endometriosis. Cochrane Database Syst Rev. 2019. https://doi.org/10.1002/14651858.CD013240.pub2.

10.

Sallam HN, Garcia-Velasco JA, Dias S, Arici A, Abou-Setta AM. Long-term pituitary down-regulation before in vitro fertilization (IVF) for women with endometriosis. Cochrane Database Syst Rev. 2006;(1):CD004635. https://doi.org/10.1002/14651858.CD004635.pub2.

11.

de Paula AM, Lopes LA, Baracat EC, Podgaec S. Dienogest in the treatment of endometriosis: systematic review. Arch Gynecol Obstet. 2015;292:523–9.CrossRef

12.

McCormack PL. Dienogest. Drugs. 2010;70(16):2073–88. https://doi.org/10.2165/11206320-000000000-00000.CrossRefPubMed

13.

Strowitzki T, Marr J, Gerlinger C, Faustmann T, Seitz C. Dienogest is as effective as leuprolide acetate in treating the painful symptoms of endometriosis: a 24-week, randomized, multicentre, open-label trial. Hum Reprod. 2010;25(3):633–41. https://doi.org/10.1093/humrep/dep469.CrossRefPubMed

14.

Bedaiwy MA, Allaire C, Alfaraj S. Long-term medical management of endometriosis with dienogest and with a gonadotropin-releasing hormone agonist and add-back hormone therapy. Fertil Steril. 2017;107(3):537–48. https://doi.org/10.1016/j.fertnstert.2016.12.024.CrossRefPubMed

15.

Vercellini P, Buggio L, Frattaruolo MP, Borghi A, Dridi D, Somigliana E. Medical treatment of endometriosis-related pain. Best Pract Res Clin Obstet Gynaecol. 2018;51:68–91. https://doi.org/10.1016/j.bpobgyn.2018.01.015.CrossRefPubMed

16.

Tamura H, Yoshida H, Kikuchi H, Josaki M, Mihara Y, Shirafuta Y, et al. The clinical outcome of Dienogest treatment followed by in vitro fertilization and embryo transfer in infertile women with endometriosis. J Ovarian Res. 2019;12(1):123. https://doi.org/10.1186/s13048-019-0597-y.CrossRefPubMedPubMedCentral

17.

Barra F, Laganà AS, Scala C, Garzon S, Ghezzi F, Ferrero S. Pretreatment with dienogest in women with endometriosis undergoing IVF after a previous failed cycle. Reprod BioMed Online. 2020;41(5):859–68. https://doi.org/10.1016/j.rbmo.2020.07.022.CrossRefPubMed

18.

Boivin J, Takefman J, Braverman A. The fertility quality of life (FertiQoL) tool: development and general psychometric properties. Hum Reprod. 2011;26(8):2084–91. https://doi.org/10.1093/humrep/der171.CrossRefPubMedPubMedCentral

19.

Rickes D, Nickel I, Kropf S, Kleinstein J. Increased pregnancy rates after ultralong postoperative therapy with gonadotropin-releasing hormone analogs in patients with endometriosis. Fertil Steril. 2002;78(4):757–62. https://doi.org/10.1016/S0015-0282(02)03338-1.CrossRefPubMed

Title: Role of suppression of endometriosis with progestins before IVF-ET: a non-inferiority randomized controlled trial
Authors: Eissa Khalifa
Hashem Mohammad
Ameer Abdullah
Mazen Abdel-Rasheed
Mohammed Khairy
Mahmoud Hosni
Publication date: 01-12-2021
Publisher: BioMed Central
Keywords: ICSI
Endometriosis
Dienogest
GnRH Agonists
Progestin
Published in: BMC Pregnancy and Childbirth / Issue 1/2021
Electronic ISSN: 1471-2393
DOI: https://doi.org/10.1186/s12884-021-03736-2

2024 ASCO Annual Meeting

Springer Medicine

Role of suppression of endometriosis with progestins before IVF-ET: a non-inferiority randomized controlled trial

Abstract

Background

Methods

Results

Conclusion

Trial registration

2024 ASCO Annual Meeting

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Trial registration

Please log in to get access to this content

Other articles of this Issue 1/2021

Repair of the myometrial scar defect at repeat caesarean section: a modified surgical technique

Perceived differences on the role of traditional birth attendants in rural Tanzania: a qualitative study

A very preterm infant born to mother of mirror syndrome secondary to fetomaternal hemorrhage: a case report

The association of timing of repeat cesarean with outcomes among a cohort of Guatemalan women with a history of prior cesarean birth

Between a woman and her fetus: Bedouin women mediators advance the health of pregnant women and babies in their society

Ovarian cyst elevation using a metreurynter for laparoscopic cystectomy of a benign ovarian cyst during pregnancy