Dados do Trabalho

Title

TREATMENT FOR ENDOMETRIOSIS BEFORE IN VITRO FERTILIZATION IN INFERTILE WOMEN WHO WISH TO BECOME PREGNANT: A SYSTEMATIC REVIEW

Objective

To evaluate treatment for endometriosis prior to IVF in infertile women who wish to become pregnant.

Methods

PUBMED search, conducted in May 2023, with the MESH descriptors "Endometriosis" and "Fertilization in Vitro", articulated with the Boolean operator "AND". We found 1451 publications and, after the filters "randomized controlled trials" and "last 5 years", there were a total of 16 articles. With reading of the titles, 8 studies were selected and, after evaluation of the abstracts, there were a total of 7 articles.

Results

Endometriosis is considered the most intractable cause of female infertility. From the analysis of the articles, it was observed that the performance of treatment for endometriosis before in vitro fertilization and embryo transfer (IVF-ET) is an important strategy to improve the results of ET-IVF for infertile women with endometriosis. In this context, it was found that the performance of treatment with dienogest (DNG) immediately before IVF-ET did not provide any benefit to improve the clinical outcomes of infertile women with endometriosis, since the number of growing follicles, recovered oocytes, fertilized oocytes, blastocysts, fertilization rates, cumulative pregnancy rate and live birth rate were lower in the group that used DNG than in the control group. In addition, it was found that three months of treatment with gonadotropin-releasing hormone (GnRH-a) agonists before in vitro fertilization promotes lower concentration of cytokines in the follicular fluid and a higher fertilization rate, but the implantation rate, embryonic quality and clinical pregnancy rate in infertile women with endometriosis had no statistically significant difference from the group that did not receive GnRH-a, so it is a questionable method, and may or may not improve the success rate of pregnancy. It was also evaluated that the effect of vitamin C (VitC) supplementation on the results of in vitro fertilization-embryo transfer (IVF-ET) in women with endometriosis did not affect markers of oxidative stress in these patients, only improved serum VitC levels. Finally, we observed the efficacy of different progestogens in women with advanced endometriosis undergoing controlled ovarian hyperstimulation for in vitro fertilization and it was found that the three protocols of medroxyprogesterone acetate plus human menopausal gonadotropin (hMG), didrogesterone plus hMG and progesterone plus hMG are equivalent in terms of fertilization and pregnancy outcomes for women with advanced endometriosis, thus, this protocol may be an alternative choice for women with severe endometriosis and normal ovarian reserve undergoing IVF/ICSI.

Conclusion

The correct follow-up of patients undergoing endometriosis treatment who wish to regain fertility and become pregnant is essential, but it is known that the use of dienogest did not generate benefit, that the use of gonadotropin-releasing hormone agonists before in vitro fertilization is questionable, that the use of vitamin C in the results of in vitro fertilization of embryos did not affect markers of oxidative stress and that the three different protocols with progestogens are equivalents and may be an alternative for women with severe endometriosis. But even so, it is concluded that none of these methods was totally effective and safe.

Keywords

Endometriosis; Therapeutics; Infertile; In Vitro Fertilization.