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

摘要

Study 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 669months and 216 COH+IUI cycles, and patients with stage III/IV endometriosis attempted spontaneous pregnancy for 379months 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 invitro fertilization.