Reproductive techniques, assisted Archives - Revista Brasileira de Ginecologia e Obstetrícia
, , , , , Summary
Revista Brasileira de Ginecologia e Obstetrícia. 09-18-2024;46:e-rbgo70
, , , , , , To compare outcomes in patients with repeated implantation failure undergoing Intracytoplasmic Sperm Injection/In vitro fertilization (IVF/ICSI) plus immunosuppressants such as prednisolone, prednisone, or cyclosporine A versus the use of IVF/ICSI alone.
Databases were systematically searched in PubMed, Cochrane, and Embase databases in September 2023.
Randomized clinical trials and observational studies with the outcomes of interest were included.
We computed odds ratios (ORs) for binary endpoints, with 95% confidence intervals (CIs). Heterogeneity was assessed using I2 statistics. Data were analyzed using Review Manager 5.4.The main outcomes were live birth, miscarriage, implantation rate, clinical pregnancy, and biochemical pregnancy.
Seven studies with 2,829 patients were included. Immunosuppressive treatments were used in 1,312 (46.37%). Cyclosporine A improved implantation rate (OR 1.48; 95% CI 1.01-2.18) and clinical pregnancy (1.89, 95% CI 1.14-3.14). Compared to non-immunosuppressive treatment, prednisolone and prednisone did not improve live birth (OR 1.13, 95% CI 0.88-1.46) and miscarriage (OR 1.49, 95% CI 1.07-2.09). Prednisolone showed no significant effect in patients undergoing IVF/ICSI, clinical pregnancy (OR 1.34; 95% CI 0.76-2.36), or implantation rate (OR 1.36; 95% CI 0.76-2.42).
Cyclosporine A may promote implantation and clinical pregnancy rates. However, given the limited sample size, it is important to approach these findings with caution. Our results indicate that prednisolone and prednisone do not have any beneficial effects on clinical outcomes of IVF/ICSI patients with repeated implantation failure.
CRD42023449655
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 09-18-2024;46:e-rbgo70
, , , , , , To compare outcomes in patients with repeated implantation failure undergoing Intracytoplasmic Sperm Injection/In vitro fertilization (IVF/ICSI) plus immunosuppressants such as prednisolone, prednisone, or cyclosporine A versus the use of IVF/ICSI alone.
Databases were systematically searched in PubMed, Cochrane, and Embase databases in September 2023.
Randomized clinical trials and observational studies with the outcomes of interest were included.
We computed odds ratios (ORs) for binary endpoints, with 95% confidence intervals (CIs). Heterogeneity was assessed using I2 statistics. Data were analyzed using Review Manager 5.4.The main outcomes were live birth, miscarriage, implantation rate, clinical pregnancy, and biochemical pregnancy.
Seven studies with 2,829 patients were included. Immunosuppressive treatments were used in 1,312 (46.37%). Cyclosporine A improved implantation rate (OR 1.48; 95% CI 1.01-2.18) and clinical pregnancy (1.89, 95% CI 1.14-3.14). Compared to non-immunosuppressive treatment, prednisolone and prednisone did not improve live birth (OR 1.13, 95% CI 0.88-1.46) and miscarriage (OR 1.49, 95% CI 1.07-2.09). Prednisolone showed no significant effect in patients undergoing IVF/ICSI, clinical pregnancy (OR 1.34; 95% CI 0.76-2.36), or implantation rate (OR 1.36; 95% CI 0.76-2.42).
Cyclosporine A may promote implantation and clinical pregnancy rates. However, given the limited sample size, it is important to approach these findings with caution. Our results indicate that prednisolone and prednisone do not have any beneficial effects on clinical outcomes of IVF/ICSI patients with repeated implantation failure.
CRD42023449655
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 05-20-2010;32(3):118-125
DOI 10.1590/S0100-72032010000300004
PURPOSE: to compare the serum levels of five markers of oxidative stress and assisted reproduction (AR) outcomes among infertile patients, with tubal and/or male factor and with polycystic ovary syndrome (PCOS). METHODS: 70 patients were included, 58 with tubal and/or male factor infertility and 12 with PCOS, who underwent controlled ovarian stimulation to perform intracytoplasmic sperm injection (ICSI). A blood sample was collected between the third and fifth day of the menstrual cycle in the month prior to ovarian stimulation. We analyzed the levels of malondialdehyde, hydroperoxides, protein oxidation products, glutathione and vitamin E, by reading the absorbance with a spectrophotometer and by high performance liquid chromatography (HPLC). Data were analyzed statistically by the Student's t-test and Fisher's exact test. RESULTS: significant increases in the body mass index, ovarian volume and number of antral follicles were observed in PCOS patients, as well as the use of a lower total dose of follicle stimulating hormone for these patients. There were no differences in the response to ovarian stimulation, in the results of AR or serum levels of malondialdehyde, hydroperoxides, advanced oxidation protein products, glutathione and vitamin E between groups. CONCLUSIONS: the present data did not demonstrate a difference in the levels of serum markers of oxidative stress or in AR results when comparing non-obese infertile patients with PCOS and controls. These data suggest that the results of AR may not be compromised in this specific subgroup of patients with PCOS. However, interpretations of the action of oxidative stress on the results of AR are still not clear and the reproductive implications of oxidative stress need to be better evaluated.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 05-20-2010;32(3):118-125
DOI 10.1590/S0100-72032010000300004
PURPOSE: to compare the serum levels of five markers of oxidative stress and assisted reproduction (AR) outcomes among infertile patients, with tubal and/or male factor and with polycystic ovary syndrome (PCOS). METHODS: 70 patients were included, 58 with tubal and/or male factor infertility and 12 with PCOS, who underwent controlled ovarian stimulation to perform intracytoplasmic sperm injection (ICSI). A blood sample was collected between the third and fifth day of the menstrual cycle in the month prior to ovarian stimulation. We analyzed the levels of malondialdehyde, hydroperoxides, protein oxidation products, glutathione and vitamin E, by reading the absorbance with a spectrophotometer and by high performance liquid chromatography (HPLC). Data were analyzed statistically by the Student's t-test and Fisher's exact test. RESULTS: significant increases in the body mass index, ovarian volume and number of antral follicles were observed in PCOS patients, as well as the use of a lower total dose of follicle stimulating hormone for these patients. There were no differences in the response to ovarian stimulation, in the results of AR or serum levels of malondialdehyde, hydroperoxides, advanced oxidation protein products, glutathione and vitamin E between groups. CONCLUSIONS: the present data did not demonstrate a difference in the levels of serum markers of oxidative stress or in AR results when comparing non-obese infertile patients with PCOS and controls. These data suggest that the results of AR may not be compromised in this specific subgroup of patients with PCOS. However, interpretations of the action of oxidative stress on the results of AR are still not clear and the reproductive implications of oxidative stress need to be better evaluated.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 10-16-2008;30(8):413-419
DOI 10.1590/S0100-72032008000800007
PURPOSE: to evaluate the meiotic spindle and the chromosome distribution of in vitro mature oocytes from stimulated cycles of infertile women with endometriosis, and with male and/or tubal infertility factors (Control Group), comparing the rates of in vitro maturation (IVM) between the two groups evaluated. METHODS: fourteen patients with endometriosis and eight with male and/or tubal infertility factors, submitted to ovarian stimulation for intracytoplasmatic sperm injection have been prospectively and consecutively selected, and formed a Study and Control Group, respectively. Immature oocytes (46 and 22, respectively, from the Endometriosis and Control Groups) were submitted to IVM. Oocytes presenting extrusion of the first polar corpuscle were fixed and stained for microtubules and chromatin evaluation through immunofluorescence technique. Statistical analysis has been done by the Fisher's exact test, with statistical significance at p<0.05. RESULTS: there was no significant difference in the IVM rates between the two groups evaluated (45.6 and 54.5% for the Endometriosis and Control Groups, respectively). The chromosome and meiotic spindle organization was observed in 18 and 11 oocytes from the Endometriosis and Control Groups, respectively. In the Endometriosis Group, eight oocytes (44.4%) presented themselves as normal metaphase II (MII), three (16.7%) as abnormal MII, five (27.8%) were in telophase stage I and two (11.1%) underwent parthenogenetic activation. In the Control Group, five oocytes (45.4%) presented themselves as normal MII, three (27.3%) as abnormal MII, one (9.1%) was in telophase stage I and two (18.2%) underwent parthenogenetic activation. There was no significant difference in meiotic anomaly rate between the oocytes in MII from both groups. CONCLUSIONS: the present study data did not show significant differences in the IVM or in the meiotic anomalies rate between the IVM oocytes from stimulated cycles of patients with endometriosis, as compared with controls. Nevertheless, they have suggested a delay in the outcome of oocyte meiosis I from patients with endometriosis, shown by the higher proportion of oocytes in telophase I observed in this group.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 10-16-2008;30(8):413-419
DOI 10.1590/S0100-72032008000800007
PURPOSE: to evaluate the meiotic spindle and the chromosome distribution of in vitro mature oocytes from stimulated cycles of infertile women with endometriosis, and with male and/or tubal infertility factors (Control Group), comparing the rates of in vitro maturation (IVM) between the two groups evaluated. METHODS: fourteen patients with endometriosis and eight with male and/or tubal infertility factors, submitted to ovarian stimulation for intracytoplasmatic sperm injection have been prospectively and consecutively selected, and formed a Study and Control Group, respectively. Immature oocytes (46 and 22, respectively, from the Endometriosis and Control Groups) were submitted to IVM. Oocytes presenting extrusion of the first polar corpuscle were fixed and stained for microtubules and chromatin evaluation through immunofluorescence technique. Statistical analysis has been done by the Fisher's exact test, with statistical significance at p<0.05. RESULTS: there was no significant difference in the IVM rates between the two groups evaluated (45.6 and 54.5% for the Endometriosis and Control Groups, respectively). The chromosome and meiotic spindle organization was observed in 18 and 11 oocytes from the Endometriosis and Control Groups, respectively. In the Endometriosis Group, eight oocytes (44.4%) presented themselves as normal metaphase II (MII), three (16.7%) as abnormal MII, five (27.8%) were in telophase stage I and two (11.1%) underwent parthenogenetic activation. In the Control Group, five oocytes (45.4%) presented themselves as normal MII, three (27.3%) as abnormal MII, one (9.1%) was in telophase stage I and two (18.2%) underwent parthenogenetic activation. There was no significant difference in meiotic anomaly rate between the oocytes in MII from both groups. CONCLUSIONS: the present study data did not show significant differences in the IVM or in the meiotic anomalies rate between the IVM oocytes from stimulated cycles of patients with endometriosis, as compared with controls. Nevertheless, they have suggested a delay in the outcome of oocyte meiosis I from patients with endometriosis, shown by the higher proportion of oocytes in telophase I observed in this group.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 10-08-2007;29(6):303-309
DOI 10.1590/S0100-72032007000600005
PURPOSE: to assess the level of lipid peroxidation (LP) and vitamin E in the follicular fluid and serum of infertile patients, with or without endometriosis, submitted to induction of ovulation for assisted reproduction procedures. METHODS: infertile patients aged 20 to 38 years old were selected prospectively and consecutively and divided into Endometriosis Group (17 patients with pelvic endometriosis) and Control Group (19 patients with previous tubal ligation or with male factor). Blood samples were collected on: D1 (before the beginning of the use of gonadotrophins), D2 (day of human chorionic gonadotrofin application) and D3 (day of oocyte retrieval). On D3, follicular fluid samples free from blood contamination were also collected and stored. LP was assessed for malondialdehyde (MDA) quantification by spectrophotometry, and antioxidant status by measurement of vitamin E by HLPC. RESULTS: on D1, no significant difference in LP was observed between groups. However, vitamin E levels were significantly higher in the Control Group. On D2, LP levels were significantly higher in the Endometriosis Group compared to Control and vitamin E levels continued to be significantly higher in the Control Group. On D3, there was no significant difference in both serum and follicular fluid levels of LP or vitamin E between groups. However, on D3, vitamin E levels were found to be significantly higher in serum than in follicular fluid in both groups, whereas MDA levels were significantly lower in follicular fluid than in serum only in the Control Group. CONCLUSION: before the beginning of the induction of ovulation, a significant decrease in antioxidant status was observed in patients with endometriosis, perhaps because antioxidants are consumed during oxidation reactions. After the induction of ovulation with exogenous gonadotrophins, the group of patients with endometriosis presented not only increased lipid peroxidation compared to Control, but also maintained a lower antioxidant status than the Control Group. However, on the day of oocyte retrieval, both serum LP potential and the levels of vitamin E were found to be similar in both groups.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 10-08-2007;29(6):303-309
DOI 10.1590/S0100-72032007000600005
PURPOSE: to assess the level of lipid peroxidation (LP) and vitamin E in the follicular fluid and serum of infertile patients, with or without endometriosis, submitted to induction of ovulation for assisted reproduction procedures. METHODS: infertile patients aged 20 to 38 years old were selected prospectively and consecutively and divided into Endometriosis Group (17 patients with pelvic endometriosis) and Control Group (19 patients with previous tubal ligation or with male factor). Blood samples were collected on: D1 (before the beginning of the use of gonadotrophins), D2 (day of human chorionic gonadotrofin application) and D3 (day of oocyte retrieval). On D3, follicular fluid samples free from blood contamination were also collected and stored. LP was assessed for malondialdehyde (MDA) quantification by spectrophotometry, and antioxidant status by measurement of vitamin E by HLPC. RESULTS: on D1, no significant difference in LP was observed between groups. However, vitamin E levels were significantly higher in the Control Group. On D2, LP levels were significantly higher in the Endometriosis Group compared to Control and vitamin E levels continued to be significantly higher in the Control Group. On D3, there was no significant difference in both serum and follicular fluid levels of LP or vitamin E between groups. However, on D3, vitamin E levels were found to be significantly higher in serum than in follicular fluid in both groups, whereas MDA levels were significantly lower in follicular fluid than in serum only in the Control Group. CONCLUSION: before the beginning of the induction of ovulation, a significant decrease in antioxidant status was observed in patients with endometriosis, perhaps because antioxidants are consumed during oxidation reactions. After the induction of ovulation with exogenous gonadotrophins, the group of patients with endometriosis presented not only increased lipid peroxidation compared to Control, but also maintained a lower antioxidant status than the Control Group. However, on the day of oocyte retrieval, both serum LP potential and the levels of vitamin E were found to be similar in both groups.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 07-30-2007;29(4):205-210
DOI 10.1590/S0100-72032007000400007
PURPOSE: to evaluate the experience of an assisted reproduction center that uses depot administration of half-dose of GnRH agonist for pituitary suppression in assisted reproductive cycles. METHODS: prospective study that evaluated in vitro fertilization or intracytoplasmatic sperm injection (IVF/ICSI) cycles utilizing half-dose of leuprolide acetate between August 2005 and March 2006. Recombinant FSH was administered for controlled ovarian induction based on the protocol. hCG was administered when at least one follicle reached 19 mm in diameter. IVF or ICSI was performed according to infertility factor. Up to four embryos were transferred on the second or third day after oocyte retrieval. Progesterone supplementation was initiated on the same day of oocyte retrieval, and after 14 days beta-hCG was measured. The following parameters were evaluated: number of aspirated cycles, cancelled cycles, transferred cycles, total dose of FSH employed, number of mature oocytes retrieved, fertilization rate, number of transferred embryos, embryo implantation rate, and pregnancy rate. RESULTS: A hundred and nine IVF/ICSI cycles were initiated. The mean age of the patients was 34.9 years. We observed 1.8% of cancellation rate. The mean total dose of gonadotrophins employed was 1,905 IU per cycle. We obtained 86.5% of mature oocytes and the fertilization rate was 76.3%. The mean number of embryos transferred was 2.7. Pregnancy rates per aspiration and per transfer were 25.2 and 25.7%, respectively. Of those who reached pregnancy, 26.3% were twins and 5.3% were triplets. CONCLUSIONS: the half-dose of GnRH depot employed for pituitary suppression was a useful alternative for ovarian stimulation in IVF cycles because it is comfortable and practical for the patient, besides its low cost.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 07-30-2007;29(4):205-210
DOI 10.1590/S0100-72032007000400007
PURPOSE: to evaluate the experience of an assisted reproduction center that uses depot administration of half-dose of GnRH agonist for pituitary suppression in assisted reproductive cycles. METHODS: prospective study that evaluated in vitro fertilization or intracytoplasmatic sperm injection (IVF/ICSI) cycles utilizing half-dose of leuprolide acetate between August 2005 and March 2006. Recombinant FSH was administered for controlled ovarian induction based on the protocol. hCG was administered when at least one follicle reached 19 mm in diameter. IVF or ICSI was performed according to infertility factor. Up to four embryos were transferred on the second or third day after oocyte retrieval. Progesterone supplementation was initiated on the same day of oocyte retrieval, and after 14 days beta-hCG was measured. The following parameters were evaluated: number of aspirated cycles, cancelled cycles, transferred cycles, total dose of FSH employed, number of mature oocytes retrieved, fertilization rate, number of transferred embryos, embryo implantation rate, and pregnancy rate. RESULTS: A hundred and nine IVF/ICSI cycles were initiated. The mean age of the patients was 34.9 years. We observed 1.8% of cancellation rate. The mean total dose of gonadotrophins employed was 1,905 IU per cycle. We obtained 86.5% of mature oocytes and the fertilization rate was 76.3%. The mean number of embryos transferred was 2.7. Pregnancy rates per aspiration and per transfer were 25.2 and 25.7%, respectively. Of those who reached pregnancy, 26.3% were twins and 5.3% were triplets. CONCLUSIONS: the half-dose of GnRH depot employed for pituitary suppression was a useful alternative for ovarian stimulation in IVF cycles because it is comfortable and practical for the patient, besides its low cost.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 05-02-2007;29(2):103-112
DOI 10.1590/S0100-72032007000200008
Male infertility affects 10% of couples in the reproductive age worldwide and is treatable in many cases. In addition to other well-described etiologies, genetic causes of male infertility are now more commonly diagnosed. In men with prior vasectomy or varicocele, microsurgical reconstruction of the reproductive tract or varicocelectomy is more cost-effective than sperm retrieval with in vitro fertilization and intracytoplasmic sperm injection if no female fertility risk factors are present. If epididymal obstruction after vasectomy is detected or advanced female age is present, the decision to use either microsurgical reconstruction or sperm retrieval with in vitro fertilization and intracytoplasmic sperm injection should be individualized. Sperm retrieval with in vitro fertilization and intracytoplasmic sperm injection is preferred to surgical treatment when female factors requiring in vitro fertilization are present or when the chance for success with sperm retrieval and intracytoplasmic sperm injection exceeds the chance for success with surgical treatment.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 05-02-2007;29(2):103-112
DOI 10.1590/S0100-72032007000200008
Male infertility affects 10% of couples in the reproductive age worldwide and is treatable in many cases. In addition to other well-described etiologies, genetic causes of male infertility are now more commonly diagnosed. In men with prior vasectomy or varicocele, microsurgical reconstruction of the reproductive tract or varicocelectomy is more cost-effective than sperm retrieval with in vitro fertilization and intracytoplasmic sperm injection if no female fertility risk factors are present. If epididymal obstruction after vasectomy is detected or advanced female age is present, the decision to use either microsurgical reconstruction or sperm retrieval with in vitro fertilization and intracytoplasmic sperm injection should be individualized. Sperm retrieval with in vitro fertilization and intracytoplasmic sperm injection is preferred to surgical treatment when female factors requiring in vitro fertilization are present or when the chance for success with sperm retrieval and intracytoplasmic sperm injection exceeds the chance for success with surgical treatment.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 03-19-2007;28(12):715-720
DOI 10.1590/S0100-72032006001200005
PURPOSE: to investigate the effects of previous bilateral tubal sterilization on the outcome of in vitro fertilization. METHODS: retrospective study of 98 consecutive in vitro fertilization cycles. Fifty-five women with previous tubal sterilization without any other infertility factor (TL group) were compared with 43 women with infertility due only to mild male factor (MI group. Age, cancellation rate per induction cycle, response to ovulation induction (number of days of ovulation induction, total amount of gonadotrophin units used, number of follicles and oocytes retrieved), fertilization and cleavage rates, number of transferred embryos and clinical pregnancy per transfer cycle were the variables considered. RESULTS: the cycle discontinuation rate due to poor response, results of ovulation induction, fertilization and cleavage rates, number of transferred embryos and the occurrence of clinical pregnancy were similar in both groups. Considering solely the variable age in TL group, we observed that patients older than 35 years required higher gonadotrophin doses during ovulation induction (2445 versus 2122 IU), presented lower response with fewer follicular growth (11.3 versus 15.8) and less oocytes retrieved (6.1 versus 8.5) compared to younger women (34 years old or less). CONCLUSIONS: tubal sterilization did not interfere with in vitro fertilization outcomes. We observed a worse response to ovulation induction in women older than 35 years, who had previous tubal sterilization.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 03-19-2007;28(12):715-720
DOI 10.1590/S0100-72032006001200005
PURPOSE: to investigate the effects of previous bilateral tubal sterilization on the outcome of in vitro fertilization. METHODS: retrospective study of 98 consecutive in vitro fertilization cycles. Fifty-five women with previous tubal sterilization without any other infertility factor (TL group) were compared with 43 women with infertility due only to mild male factor (MI group. Age, cancellation rate per induction cycle, response to ovulation induction (number of days of ovulation induction, total amount of gonadotrophin units used, number of follicles and oocytes retrieved), fertilization and cleavage rates, number of transferred embryos and clinical pregnancy per transfer cycle were the variables considered. RESULTS: the cycle discontinuation rate due to poor response, results of ovulation induction, fertilization and cleavage rates, number of transferred embryos and the occurrence of clinical pregnancy were similar in both groups. Considering solely the variable age in TL group, we observed that patients older than 35 years required higher gonadotrophin doses during ovulation induction (2445 versus 2122 IU), presented lower response with fewer follicular growth (11.3 versus 15.8) and less oocytes retrieved (6.1 versus 8.5) compared to younger women (34 years old or less). CONCLUSIONS: tubal sterilization did not interfere with in vitro fertilization outcomes. We observed a worse response to ovulation induction in women older than 35 years, who had previous tubal sterilization.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 02-07-2007;28(10):612-623
DOI 10.1590/S0100-72032006001000008
Despite a wide heterogeneity of clinical manifestations related to endometriosis, a high prevalence of the disease is observed in infertile women and in those with chronic pelvic pain. This enigmatic condition has a high socioeconomic impact, and the described data regarding efficacy of the therapeutic approaches are quite conflicting. Thus, the purpose of the present study was to describe the available scientific evidence about the applicable therapeutic modalities and to provide recommendations for the treatment of infertility and the chronic pelvic pain related to endometriosis. Although suppression of ovarian function in patients with minimal or mild endometriosis is not effective in improving fertility, ablation of the lesions associated with adhesiolysis seems to be more effective than exclusive diagnostic laparoscopy. There is no sufficient evidence to determine whether surgical excision in cases of moderate or severe disease would improve the pregnancy rates. In vitro fertilization seems to be an adequate approach, especially in cases of coexistence of infertility factors and/or failure of other treatments. The possibility of using GnRH for 3 to 6 months before in vitro fertilization should be considered. Regarding pain relief, suppression of ovarian function for 3 to 6 months in patients with laparoscopically-confirmed disease reduces the pain associated with endometriosis. All studied medication seem to have similar efficacy, differing only in terms of adverse effects and costs. Ablation of endometriotic lesion reduces the pain associated with endometriosis, being less effective in cases of minimal disease. Exeresis of endometriomas with diameter > 4 cm seems to improve the rate of natural fecundity and the rate for ??? obtained after assisted reproduction procedures, in addition to reducing both pain and recurrence risk. Finally, it is important to emphasize that this subject is much controversial and the recommendations herein described should be revised as randomized controlled clinical trials with adequate casuistic generate more concrete and reliable evidence.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 02-07-2007;28(10):612-623
DOI 10.1590/S0100-72032006001000008
Despite a wide heterogeneity of clinical manifestations related to endometriosis, a high prevalence of the disease is observed in infertile women and in those with chronic pelvic pain. This enigmatic condition has a high socioeconomic impact, and the described data regarding efficacy of the therapeutic approaches are quite conflicting. Thus, the purpose of the present study was to describe the available scientific evidence about the applicable therapeutic modalities and to provide recommendations for the treatment of infertility and the chronic pelvic pain related to endometriosis. Although suppression of ovarian function in patients with minimal or mild endometriosis is not effective in improving fertility, ablation of the lesions associated with adhesiolysis seems to be more effective than exclusive diagnostic laparoscopy. There is no sufficient evidence to determine whether surgical excision in cases of moderate or severe disease would improve the pregnancy rates. In vitro fertilization seems to be an adequate approach, especially in cases of coexistence of infertility factors and/or failure of other treatments. The possibility of using GnRH for 3 to 6 months before in vitro fertilization should be considered. Regarding pain relief, suppression of ovarian function for 3 to 6 months in patients with laparoscopically-confirmed disease reduces the pain associated with endometriosis. All studied medication seem to have similar efficacy, differing only in terms of adverse effects and costs. Ablation of endometriotic lesion reduces the pain associated with endometriosis, being less effective in cases of minimal disease. Exeresis of endometriomas with diameter > 4 cm seems to improve the rate of natural fecundity and the rate for ??? obtained after assisted reproduction procedures, in addition to reducing both pain and recurrence risk. Finally, it is important to emphasize that this subject is much controversial and the recommendations herein described should be revised as randomized controlled clinical trials with adequate casuistic generate more concrete and reliable evidence.