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

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MOHAK INFERTILITY CENTRE
Our Location
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Dr. Shilpa Bhandari
MD GynaecologyDM Reproductive Medicine and
Surgery
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Pretreatment with dienogest in women with
endometriosis undergoing IVF after a previous
failed cycle
 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.

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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.
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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.
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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 lt 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.
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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.
Source - https//www.sciencedirect.com/science/ar
ticle/abs/pii/S147264832030393X
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