IVF in patients with endometriosis

Question 1

IUI in endometriosis

Answer 1

• Women with AFS/ASRM stage I/II endometriosis: IUI with controlled ovarian stimulation, instead of expectant management, and instead of IUI alone as it increases live birth rates
• Within 6 months of surgical tx

Question 2

IVF and endometriosis

Answer 2

• Especially if tubal function is compromised or if there is male factor infertility, and/or other treatments have failed.
• Ok after surgery, since cumulative endometriosis recurrence rates are not increased after controlled
  ovarian stimulation for IVF/ICSI
• In women with endometrioma, clinicians may use antibiotic prophylaxis at the time of oocyte retrieval, although the risk of ovarian abscess following follicle aspiration is low

Question 3

Medical tx prior to IVF in endometriosis

Answer 3

Prescribe GnRH agonists for a period of 3 to 6 months

prior to treatment with IVF to improve clinical pregnancy rates in infertile women with endometriosis

Question 4

Tx of endometrioma prior to IVF

Answer 4

• In infertile women with endometrioma larger than 3 cm there is no evidence that cystectomy prior to treatment with IVF improves pregnancy rates
• endometrioma larger than 3 cm, consider cystectomy prior to assisted IVF only to improve endometriosis-associated pain or the accessibility of follicles
• Counsel women with endometrioma regarding the risks of reduced ovarian function after surgery and the possible loss of the ovary. The decision to proceed
  with surgery should be considered carefully if the woman has had previous ovarian surgery