Long-term pituitary down-regulation may increase IVF success for women with endometriosis

This study evaluated the use of long-term pituitary down-regulation before in vitro fertilization (IVF) in patients with severe endometriosis.

Endometriosis is found in many women suffering from decreased fertility. IVF, with or without the use of intracytoplasmic sperm injection (injection of a single sperm directly into the egg for fertilization), is often used to achieve pregnancy in women with endometriosis. However, IVF success rates remain lower among women with severe endometriosis compared to infertility from other causes. In addition, only few studies have reported the rate of complications and recurrences among women with endometriosis undergoing IVF.

Pituitary down-regulation (suppression of the pituitary gland, which controls the menstrual cycle and ovulation) is often the first step during IVF. Previous trials have suggested that long-term pituitary down-regulation, for 3 to 6 months prior to IVF, may improve pregnancy rates among women with endometriosis.

This trial included 113 women with severe endometriosis undergoing IVF. 68 women were treated with long-term pituitary down-regulation for an average of 3 months prior to IVF. The remaining 45 women did not receive any extended pituitary down-regulation prior to IVF. Overall, 34 (30.1%) ongoing pregnancies were achieved.

35.3% of those treated with pituitary down-regulation achieved an ongoing pregnancy, compared to 22.2% of patients not treated with long-term pituitary down-regulation. Overall, 3 complications and 3 recurrences of the disease were reported; all in the group treated with long-term pituitary down-regulation.

This study concluded that IVF is a safe procedure for women with endometriosis, with low complication and recurrence rates. Long term pituitary down-regulation prior to IVF may increase pregnancy rates among women with endometriosis.

This retrospective study included only a small number of women and failed to produce statistically conclusive results.