In a nutshell
This study looked at priming for in vitro fertilization (IVF) using dienogest (Visanne), which can reduce symptoms of endometriosis. It found that patients with endometriosis can use dienogest during IVF treatment.
Endometriosis is a condition in which cells from the lining of the uterus grow in other places, such as on the ovaries or in the abdomen. When levels of estrogen are high endometriosis lesions grow and spread. These lesions can damage the tissue of the ovaries, reducing fertility.
Dienogest is a medication similar to the hormone progesterone which can treat endometriosis. It prevents ovulation and the high estrogen levels leading up to ovulation. Additionally, dienogest reduces endometriosis cells’ ability to shed and implant in other places.
Traditionally, patients with endometriosis stop dienogest treatment before beginning the infertility treatment IVF. IVF requires medications to reduce the body’s own hormones, the most common being GnRH agonist. However, IVF can also be prepared for with another progesterone-like medication known as dydrogesterone (DYG; Duphaston). It is unclear whether dienogest can also be used during IVF to reduce the body’s own hormones.
Methods & findings
This study included 150 patients with endometriosis who planned to undergo IVF. Any large endometrial cysts on the ovaries (over 4 cm) were removed surgically. 73 patients who had a high risk of endometriosis returning were treated with dienogest for at least two months. These patients continued dienogest during IVF. The other 77 patients started DYG at the same time as ovarian stimulation medications for IVF.
Fewer oocytes (eggs) were retrieved for patients taking dienogest (6.18 vs. 9.85). However, significantly more of the oocytes were mature for patients taking dienogest (89.1% vs. 78.9%). The proportion of oocytes which were successfully fertilized was similar for the two groups.
All of the embryos were frozen because both dienogest and DYG can thin the lining of the uterus. There were 233 frozen embryo transfers (FET) using these embryos. The ultrasound-measured pregnancy rate per FET was similar for both groups (dienogest: 50.5%, DYG: 46.8%).
The bottom line
This study found that continuing with dienogest therapy during IVF is an option for patients with endometriosis.
The fine print
The patients treated with dienogest had a higher risk of endometriosis recurring than the patients using DYG, which may influence their outcomes.
Published By :
Dec 14, 2020