Endometriosis

American association of clinical endocrinologists and american college of endocrinology comprehensive clinical practice guidelines for medical care of patients with obesity.

Background In women, anti-Mullerian hormone (AMH) levels may represent the ovarian follicular pool and could be a useful marker of ovarian reserve. The clinical application of AMH measurement has been proposed in the prediction of quantitative and qualitative aspects in assisted reproductive technologies (ART). In men AMH is secreted in both the serum and seminal fluid. Its measurement may be useful in clinical evaluation of the infertile male. Methods The PubMed database was systematically searched for studies published until the end of January 2009, search criteria relevant to AMH, ovarian reserve, ovarian response to gonadotrophin stimulation, spermatogenesis and azoospermia were used. Results AMH seems to be a better marker in predicting ovarian response to controlled ovarian stimulation than age of the patient, FSH, estradiol and inhibin B. A similar performance for AMH and antral follicular count has been reported. In clinical practice, AMH measurement may be useful in the prediction of poor response and cycle cancellation and also of hyper-response and ovarian hyperstimulation syndrome. In the male, the wide overlap of AMH values between controls and infertile men precludes this hormone from being a useful marker of spermatogenesis. Conclusions As AMH may permit the identification of both the extremes of ovarian stimulation, a possible role for its measurement may be in the individualization of treatment strategies in order to reduce the clinical risk of ART along with optimized treatment burden. It is fundamental to clarify the cost/benefit of its use in ovarian reserve testing. Regarding the role of AMH in the evaluation of infertile men, AMH as single marker of spermatogenesis does not seem to reach a satisfactory clinical utility.

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Anti-Müllerian hormone (AMH) as a predictive marker in assisted reproductive technology (ART)

Effect of endometriosis on in vitro fertilization

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(10)60490-4.pdf

Endometriosis and infertility: pathophysiology and management.

RESULTS: The cumulative live birth rate within three treatment cycles was 41.4% [95% confidence interval (CI) 32.1– 50.7] in obese women with BMI $30 kg/m 2 and 50.3 (95% CI 47.0–53.7) in normal weight women with BMI 18.5– 24.9 kg/m 2 . Obesity was associated with an increased risk of early pregnancy loss occurring before 6 weeks gestation. Positive correlation between BMI and gonadotrophin requirement during stimulation and negative correlation between BMI and number of collected oocytes were observed. Underweight (BMI < 18.5 kg/m 2 ) was not related to an impaired outcome of IVF or ICSI. CONCLUSIONS: Obesity is associated with lower chances for live birth after IVF and ICSI and with an impaired response to ovarian stimulation.

https://www.researchgate.net/profile/Peter_Fedorcsak/publication/233740615_Impact_of_overweight_and_underweight_on_assisted_reproduction_treatmen/links/00b49526ea482593e0000000.pdf?origin=publication_detail

Impact of overweight and underweight on assisted reproduction treatment

In vitro fertilization is a successful treatment in endometriosis-associated infertility

BACKGROUND: This study was undertaken in order to compare pregnancy outcome after IVF and ICSI in unexplained and endometriosis-associated infertility using tubal factor infertility as controls. METHODS: This was a retrospective cohort study of early IVF/ICSI pregnancies verified by serum hCG measurement, comparing the subsequent outcome in unexplained (n 5 274) and minimal endometriosis-associated (n 5 212) with tubal factor (n 5 540) infertility as controls. From January 1990 to December 2002, 1026 conception cycles after treatment with IVF or ICSI complied with the inclusion criteria. RESULTS: Live birth rate, twin birth rate after transfer of two embryos and abortion rate prior to 6 weeks of gestation were superior for the unexplained (78.8, 23.5 and 11.7%) compared to endometriosis-associated (66.0, 15.0 and 19.3%) and tubal factor (66.7, 18.1 and 18.0%) infertility groups ( P< 0.05). Compared to the endometriosis-associated, the unexplained infertility group attained a higher pregnancy rate after the first treatment cycle ( P< 0.05). CONCLUSIONS: The overall better outcome for the unexplained infertility group with respect to live birth rate, twin birth rate and early abortion rate compared to the minimal peritoneal endometriosis-associated and tubal factor infertility groups might be a guide to select diagnostic groups for single embryo transfer and be useful in patient counselling.

/pdf/pregnancy-outcome-after-ivf-and-icsi-in-unexplained-441otltsa2.pdf

Pregnancy outcome after IVF and ICSI in unexplained, endometriosis-associated and tubal factor infertility

Background. To compare the outcome of in vitro fertilization /embryo transfer (IVF-ET) in unexplained infertility and infertility associated with minimal peritoneal endometriosis.Methods. A retrospective analysis comparing results of stimulation, sperm characteristics, cleavage, implantation and pregnancy rates in patients with unexplained infertility and peritoneal endometriosis associated infertility Couples with tubal infertility constituted a control group.Results. In the unexplained infertility and endometriosis groups similar response to stimulation. similar sperm characteristics and cleavage rates were observed. Compared with tubal infertility lower sperm motility was seen in the unexplained infertility group. Both non tubal infertility groups had lower cleavage rate than was seen in the control group. No differences in pregnancy rate were observed, but a significantly higher implantation rate was seen in unexplained infertility compared with tubal infertility.Conclusions. Couples with unexplained ...

In vitro fertilization/embryo transfer in unexplained infertility and minimal peritoneal endometriosis

BACKGROUND: To elucidate possible differences between unexplained and minimal peritoneal endometriosisassociated infertility, we studied their outcome in natural cycle IVF (NIVF). METHODS: A prospective cohort study was carried out on unexplained (33 couples), minimal peritoneal endometriosis-associated (30 couples) and tubal factor (24 couples) infertility in 223 NIVF cycles, using human chorionic gonadotrophin (HCG) for ovulation induction. RESULTS: During the first NIVF attempt, follicular and luteal phase oestradiol, FSH, LH and progesterone concentrations, as well as endometrial thickness and follicular diameter were similar among the three groups. Periovulatory follicular growth monitored from day of HCG administration to oocyte aspiration was significantly lowered in unexplained infertility compared with minimal endometriosis-associated and tubal factor infertility. The fertilization rate, clinical pregnancy rate per initiated cycle, per successful oocyte retrieval and per embryo transfer, in minimal endometriosis (80.0, 10.4, 16.0 and 23.5% respectively) were similar to that in tubal factor infertility patients (68.6, 5.8, 11.4 and 16.0%) but significantly higher (P < 0.05) than that of the unexplained infertility group (62.2, 2.6, 5.4 and 8.7%). CONCLUSIONS: The significant reduction in follicular periovulatory growth, fertilization and pregnancy rates in unexplained infertility compared with minimal peritoneal endometriosis patients may be explained by sub-optimal follicular development with possibly reduced oocyte quality, intrinsic embryo quality factors or by impaired implantation. From a clinical point of view, NIVF is less suited to unexplained infertility treatment, but might represent an interesting treatment option for minimal peritoneal endometriosisassociated infertility.

/pdf/natural-cycle-ivf-in-unexplained-endometriosis-associated-41crh6cemx.pdf

Anne Katerine Omland

Papers

Impact of overweight and underweight on assisted reproduction treatment

In vitro fertilization is a successful treatment in endometriosis-associated infertility

Pregnancy outcome after IVF and ICSI in unexplained, endometriosis-associated and tubal factor infertility

In vitro fertilization/embryo transfer in unexplained infertility and minimal peritoneal endometriosis

Natural cycle IVF in unexplained, endometriosis-associated and tubal factor infertility.