Dados do Trabalho

Title

INFLUENTIAL FACTORS IN CONCEPTION AMONG PATIENTS WITH ENDOMETRIOSIS UNDERGOING ASSISTED REPRODUCTIVE TECHNIQUES

Objective

This literature review aims to analyze the factors influencing conception success in patients with endometriosis undergoing Assisted Reproductive Techniques (ART).

Methods

The descriptors were determined using the following Boolean operators: "(Infertility) AND (Endometriosis) AND (Assisted Reproductive Technology)." The research was conducted on the databases U.S. National Library of Medicine (PUBMED), Virtual Health Library (BVS), and ScienceDirect. The primary search was conducted by applying filters for free articles and articles published between the years 2018 and 2023, resulting in a total of 335 articles. After excluding duplicates based on title and abstract, 68 articles remained. Following a comprehensive analysis of these studies, those with the least methodological limitations were selected, resulting in a total of 11 articles.

Results

The findings regarding the use of Ovarian Stimulation Protocols (OSP) in patients with endometriosis undergoing In Vitro Fertilization (IVF) / Intracytoplasmic Sperm Injection (ICSI) / Intrauterine Insemination (IUI) are favorable to the use of hormonal techniques. The main agents highlighted for this purpose are Gonadotropin-Releasing Hormone Agonists (GnRH-a) and Gonadotropin-Releasing Hormone Antagonists (GnRH-ant). Both have shown benefits when administered before IVF/ICSI/IUI procedures.

In a case-control study, it was observed that patients treated with GnRH-a had higher Clinical Pregnancy Rate (CPR) and Live Birth Rate (LBR) compared to those without the use of GnRH-a. Concerning the use of GnRH-ant, a systematic review presented similar results regarding CPR. However, limitations were identified with the use of GnRH-ant in cases of advanced endometriosis and combined forms of endometriosis, as GnRH-a showed greater advantages, particularly when anti-Mullerian hormone levels ranged from 1.1 to 2.7 ng/ml and when fresh embryo transfer was performed, respectively.

Analyzing the dosage of GnRH and its effects, it was noted that the values of GnRH-a used are higher than those used in GnRH-ant treatment, and in this context, the use of GnRH-a predicts a lower CPR. It is worth noting, though, that the majority of current studies indicate superiority with the use of GnRH-a, as there are more retrieved oocytes available for subsequent cryopreservation. Other drugs have also been employed to improve the outcomes of ART in patients with endometriosis, such as Atosiban, which showed a significant increase in pregnancy rates in these patients.

The Ovarian Stimulation Protocol with Progestin (OSPP) was evaluated for its potential benefits when used prior to In Vitro Fertilization (IVF) for the suppression of endometriosis. A cohort study revealed that the OSPP yielded comparable results to GnRH-a and GnRH-ant protocols, with similar Implantation Rate, Clinical Pregnancy Rate (CPR), and Ongoing Pregnancy Rate as the ultra-long GnRH-a protocol (using 3.75 mg of triptorelin acetate) and the GnRH-ant protocol (0.25 mg/day). However, it is worth noting that the OSPP might be associated with inferior reproductive outcomes concerning biochemical pregnancy, clinical pregnancy, and Live Birth Rate (LBR) compared to the ultra-long GnRH-a protocol.

Conclusion

The use of GnRH-a, GnRH-ant, and PEOP has shown good results in patients with endometriosis undergoing Assisted Reproductive Technology (ART), as it promoted an increase in Total Gonadotropin Consumption (TGC) and Total Number of Viable embryos (TNV). Specifically, the analyzed literature suggests that GnRH-a exhibits superiority when compared to GnRH-ant, while PEOP has shown inferiority when compared to the other two hormonal techniques mentioned.

Keywords

Assisted reproductive technologies (ART); Endometriosis; GnRH (Gonadotropin-Releasing Hormone); Infertility; Ovarian stimulation.