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Pretreatment with dienogest in women with endometriosis undergoing IVF after a previous failed cycle

  • Fabio Barra
    Affiliations
    Academic Unit of Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino, Largo R. Benzi 10, Genoa 16132, Italy

    Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Italy

    Piazza della Vittoria 14 Srl, Piazza della Vittoria 14/26, Genova 16121, Italy
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  • Antonio Simone Laganà
    Affiliations
    Department of Obstetrics and Gynecology, ‘Filippo Del Ponte’ Hospital, University of Insubria, Varese, Italy
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  • Carolina Scala
    Affiliations
    Piazza della Vittoria 14 Srl, Piazza della Vittoria 14/26, Genova 16121, Italy

    Unit of Obstetrics and Gynaecology, Gaslini Institute, Genoa 16147, Italy
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  • Simone Garzon
    Affiliations
    Department of Obstetrics and Gynecology, ‘Filippo Del Ponte’ Hospital, University of Insubria, Varese, Italy
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  • Fabio Ghezzi
    Affiliations
    Department of Obstetrics and Gynecology, ‘Filippo Del Ponte’ Hospital, University of Insubria, Varese, Italy
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  • Simone Ferrero
    Correspondence
    Corresponding author.
    Affiliations
    Academic Unit of Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino, Largo R. Benzi 10, Genoa 16132, Italy

    Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Italy

    Piazza della Vittoria 14 Srl, Piazza della Vittoria 14/26, Genova 16121, Italy
    Search for articles by this author

      Highlights

      • IVF has worse outcomes in patients with endometriosis.
      • The prolonged use of hormone drugs before IVF may improve pregnancy outcomes.
      • Dienogest (DNG) is a progestin with anti-inflammatory and anti-angiogenic activity.
      • Implantation rates may be higher as a result of receiving DNG before IVF.
      • Clinical pregnancy rates may be higher as a result of receiving DNG before IVF.

      Abstract

      Research question

      The major causes of IVF failure in women with endometriosis have been attributed to decreased ovarian reserve, low embryo quality and impaired receptivity of the endometrium. Dienogest (DNG) has anti-inflammatory and anti-angiogenic activity and so may theoretically improve IVF outcomes in women with endometriosis. This study aimed to evaluate the administration of DNG before IVF in women with endometriosis who had previously failed one IVF cycle.

      Methods

      This study was based on the retrospective analysis of a prospectively collected database, including 151 women who had failed a previous IVF cycle and all subsequent embryo transfers and had an imaging diagnosis of endometriosis. Patients either directly underwent IVF without receiving hormonal treatment or received 3 months of treatment with DNG (2 mg/daily) before IVF.

      Results

      Eighty-eight (58.3%) patients underwent IVF without previous hormonal treatment, and 63 (41.7%) received pretreatment with DNG. The cumulative implantation, clinical pregnancy and live birth rates were significantly higher in the DNG-treated group (39.7%, 33.3% and 28.6%) than in the non-treated group (23.9%, 18.2% and 14.8%; P = 0.049, 0.037 and 0.043, respectively). The largest diameter of endometriomas significantly decreased after DNG pretreatment (P < 0.001). The use of DNG increased significantly the number of oocytes retrieved (P = 0.031), two-pronuclear embryos (P = 0.039) and blastocysts (P = 0.005) in women with endometriomas of diameter ≥4 cm.

      Conclusions

      This study suggest that in patients with endometriosis, IVF outcomes can be improved by pretreatment with DNG. In particular, the use of DNG allows for better oocyte retrieval and blastocysts in patients with large endometriomas.

      Keywords

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      Biography

      Fabio Barra has completed the Biomedical Excellence Programme at the Institute of Superior Studies of the University of Genoa. He is currently attending the medical residency programme in gynaecology and obstetrics at the same university. His areas of expertise are benign gynaecological diseases and he is the author of over 100 international publications.
      Key message
      This study showed that the cumulative implantation, clinical pregnancy and live birth rates may be improved by receiving hormonal treatment with DNG before IVF. In particular, the use of this progestin may allow for better oocyte retrieval as well as number of two-pronuclear embryos and blastocysts in women with large endometriomas.