Evaluating dienogest treatment before IVF in women with endometriosis

This study looked at using the anti-inflammatory progestin dienogest (Visanne) prior to in vitro fertilization (IVF) for patients with endometriosis with a previously failed IVF. It found that dienogest improved IVF outcomes in these women.

Endometriosis is a chronic illness in which cells from the lining of the uterus grow in other places such as the Fallopian tubes or the ovaries. Patients with endometriosis have higher levels of inflammation. Endometriosis can cause excessive menstrual bleeding and pain. Endometriosis is also a leading cause of female infertility.

IVF is one way to treat endometriosis-related infertility. However, it tends to be less successful than for other patients. One way to improve IVF for endometriosis is to reduce the body’s own hormones using a GnRH agonist such as buserelin (Suprefact). One month of GnRH agonist is a standard part of IVF treatment, but patients with endometriosis get improved outcomes from extended 3 to 6 months pretreatment.

Progestins can also prevent the brain from releasing hormones that stimulate the ovaries. These medications are similar to the hormone progesterone, and they are the active ingredients in hormonal contraception. Dienogest is a progestin that reduces inflammation and is used to treat endometriosis pain. Additionally, dienogest does not cause menopause-like side effects, as GnRH agonists can. It is not clear whether pretreatment with dienogest can improve IVF outcomes for patients with endometriosis.

This study used records from 151 patients undergoing IVF. 63 patients used pretreatment with dienogest, while 88 did not have pretreatment (control group). The two groups had similar ages, tests of ovarian reserve (number of eggs), and initial sizes of endometriosis cysts. The dienogest group received the medication for three months before IVF. After a one-cycle break, IVF medications were begun.

The size of the endometriosis cysts reduced during dienogest treatment. There was a significant reduction of 1.0 cm in the width of the largest cyst. By the time IVF ovarian stimulation was started, the widest cyst was significantly smaller for the dienogest group (2.7 vs. 3.6 cm).

There was a trend for the dienogest group to have more eggs collected (6.1 vs. 5.4) and more resulting high-quality embryos (1.3 vs. 0.9). After a fresh embryo transfer, there was a trend toward more ultrasound-confirmed pregnancies for the dienogest group (25.8% vs. 14.0%) and more live births (21.0% vs. 12.8%). Including all transfers of fresh and frozen embryos, significantly more dienogest patients had a live birth (28.6% vs. 14.8%).

Patients with large cysts over 4 cm had the most benefit. For these patients, dienogest improved the antral follicle count (AFC), which is an indication of ovarian reserve. It also improved the number of embryos collected.

This study found that dienogest pretreatment improved IVF outcomes for patients with endometriosis with a previously failed IVF.

This was a small study, and it used patient records. Additional studies are needed.