Is the endometriosis recurrence rate increased after ovarian hyperstimulation?

Area of Science:

• Reproductive Medicine
• Gynecologic Surgery
• Endocrinology

Background:

• Endometriosis is a chronic condition affecting women of reproductive age.
• Fertility surgery for advanced endometriosis (Stage III/IV) is often followed by assisted reproductive technologies.
• The impact of ovarian hyperstimulation (OH) estrogen levels on endometriosis recurrence post-surgery is not fully understood.

Purpose of the Study:

• To investigate the hypothesis that high estrogen (E2) levels during IVF-related OH increase cumulative endometriosis recurrence rate (CERR) after surgery.
• To compare CERR in women undergoing IVF with high E2 exposure versus IUI with lower E2 exposure.

Main Methods:

• Retrospective cohort study of 67 patients with endometriosis Stage III or IV who underwent fertility surgery.
• Patients received fertility treatment via IVF only, IUI only, or a combination of both.
• Life table analysis was used to calculate CERR based on confirmed disease recurrence.

Main Results:

• At 21 months post-OH, the overall CERR was 31%.
• CERR was significantly lower in the IVF-only group (7%) and the combined IVF/IUI group (43%) compared to the IUI-only group (70%).
• At 36 months, the overall CERR reached 63%.

Conclusions:

• Contrary to the hypothesis, CERR was lower after IVF OH than after IUI stimulation.
• Temporary exposure to high E2 levels during IVF OH does not appear to be a significant risk factor for endometriosis recurrence.
• These findings suggest assisted reproductive technologies may not negatively impact endometriosis recurrence post-surgery.