June 6th, 2020

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Recurrent Endometrioma in Infertile Patients Has Worse Outcome than Primary Endometrioma in Response to Controlled Ovarian Hyperstimulation and Intrauterine Insemination
Authors:  Kiyak Huseyin, M.D., Karacan Tolga, M.D., Bulut Berk, M.D., Ozyurek Eser, M.D., Gedikbasi Ali, M.D., and Api Murat, Ph.D., M.D.
  OBJECTIVE: To investigate the difference in the effectiveness of controlled ovarian hyperstimulation and intrauterine insemination (COH+IUI) on pregnancy rates in patients with pri­mary and recurrent endome­triomas.

STUDY DESIGN: Multi­ center, retrospective cohort study done in 3 tertiary referral centers. Included in the study were (1) primary infertility patients with endo­metriomas who had no other probable cause for infertility, (2) those who underwent 2 cycles of COH+IUI, provid­ed the sperm test was nor­mal, (3) those who had at least 1 patent fallopian tube, and (4) those whose ovarian reserve was normal with ovulatory cycles. Therapy for COH was hMG (meno­ tropin) or recombinant follicle­stimulating hormone (follitropin alfa, beta) at 75 IU/d starting from day 3. Trigger was done by 5,000–10,000 human chorionic gonadotropin or choriogonadotropin alfa 250 μg/0.5 mL when the dominant follicle size reached 18 mm.

RESULTS: The ongoing pregnancy rates in patients with primary endometrioma were 14.4% per patient and 8.06% per cycle. In patients with recurrent endometrio­ma, the ongoing pregnancy rates were 6.06% per patient and 3.4% per cycle. Ongoing pregnancy rates were sig­nificantly higher in patients with primary endometrioma than in recurrent endometri­ oma patients.

CONCLUSION: COH+IUI may be recommended even before surgery for couples with primary endometrio­ mas when there is no other infertility factor. COH+IUI treatment is not recommended for recurrent endome­ trioma patients.
Keywords:  adenomyosis, artificial insemination, assisted reproductive techniques, deep infiltrative endometriosis, endometrioma, endometriosis, infertility, intrauterine insemination, ovulation induction, pelvic pain/diagnosis
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