@2024 Afarand., IRAN

---

ISSN: 2251-8215    Sarem Journal of Reproductive Medicine 2019;3(1):5-8

Background
In endometriosis, the uterine endometrium grows outside the uterus, such as the abdomen and on organs such as the bladder, intestines and ovaries. The spectrum of this disease is very wide and varies from small lesions on the pelvic organs to large endometrium cysts and creates extensive adhesions in the intestine, bladder and uterus, and disturbs pelvic anatomy[1-3].
Previous Studies
Treatment of this disease, still, has a lot of problems and issues, as the only standard way to diagnose this is laparoscopy. The severity of the disease is wide. It is also possible for the disease to be returned after surgery and drug therapy[4]. There is a correlation between reduced fertility and endometriosis (33% reduction in fertility). Some studies have reported that pregnancy (endometrial admission) decreases in women with endometriosis due to reduced follicular ovarian reserve, abnormal folliculogenesis and reduced fertility ability of oocyte. Studies have also shown that the success rate of IVF in women with endometriosis is lower than those of women with other cause of infertility and the number of oocytes, fertilized oocytes, and embryos with good quality and the success rate of fertility in women with endometriosis is lower[5, 6]. In addition, a reverse relationship has been reported between degree and severity of the disease and the spontaneously Monthly Fertility Rate (MFR). In some studies, also, reduced MFR and pregnancy and post- IVF implementation in women with endometriosis has been shown. However, reports have been presented regarding the increase the level of MFR and cumulative fertility rates after surgery and endometriosis treatment for mild to moderate degrees[7].
Aim(s)
At Sarem Specialist Hospital, a new surgical-drug combination protocol is used to treat endometriosis that its success has been recorded in treating various degrees of this disease[8-10]. The aim of this study was to evaluate the fertility rate of ICSI in women after endometriosis treatment compared to healthy women.
Research type
This study is semi-experimental (non-randomized clinical trial) retrospective study.
Research society, place and time
This study was performed on 300 patients referred to IVF clinic of Sarem Women Hosptial over a period of three years and fertility of women with endometriosis (with a protocol for treatment in Sarem Hospital in Tehran) was compared with healthy women.
Sampling method and number

Used devices&materials
The treatment protocol for endometriosis which is being implemented in Sarem Women Hospital has already been established. Shortly, the treatment consists of a combination of treatment including a conservative surgery and a GnRH-mediated drug therapy (a monthly dose of decapeptide) that depending on the degree of disease, the duration is varied for each patient[9, 10]. In this study, no patient was deprived from standard treatment and details of study was approved in the ethics committee of Sarem Hospital. To investigate the effects of treatment of endometriosis on reproductive capacity of these women, factors including age, total number of oocytes, number of adult and immature oocytes, abnormal oocytes, embryo quality, success rate in chemical pregnancy (based on positive or negative -HCG) ,clinical pregnancy outcomes as well as live birth rates and compared with control group. Also, the effects of degree (grade) of this disease in endometriosis patients were analyzed on the number of healthy oocytes obtained from them. Data were analyzed by SPSS 22 software using Spearman Rank Order Coefficient, Man-Whitney, Fisher exact, and chi-square test.
Findings by Text
Mean age of total 300 subjects was 33.10±4.90 years. The mean age of people in the control and intervention group had significant difference (p=0.02). The total number of oocytes was 2242 and the total mean was 7.36±5.2. The total number of obtained adult oocytes was 1978 and the mean of total adult oocytes was 6.77±4.5. The mean of adult ocytes and the mean of immature oocytes was significantly different between the two control and intervention groups (p<0.05; Table 1) Considering the total number of embryos (regardless of their qualitative status), the overall ICSI success rate based on fertility rate was about 67.35% that 63.7% and 71.65% were obtained for the control and experimental groups respectively. The total number of obtained embryos from these people was 1510 cases (772 cases for control group and 738 for experimental group) and the mean of its total was 5.03±3.03 (5.15±3.4 in the control group and 4.92±3.2 in the intervention group) that the difference between them was not significant (p=0.72).Totally, the overall prevalence of chemical pregnancy was 27.7% based on positive -HCG (p=0.80; Table 2). The total successful pregnancy rate in the control group was 20% based on birth rate and in the intervention group was 16% (p=0.45).In the patients group, there was no correlation between age and type of fertility (based on being primary or secondary). There was no correlation between type of fertility and the number of mature and immature oocytes number. Also, there was no significant difference between the incidences of infertility treatment including chemical pregnancy, clinical pregnancy, and live birth. In the group of patients significant correlation was seen between severity of treated diseases and total number of oocytes (p=0.04), as well as the number of adult oocytes (p=0.016).
Main comparison to the similar studies
Based on previous studies, including Hamdan et al. women suffered from endometriosis have the similar rate of fertility with other women after the treatment[11]. In general, according to the fertility factors studied in this study, women treated with endometriosis did not show significant differences in fertility rates compared with healthy women which confirmed the findings of previous studies. Therefore, successful treatment of endometriosis before entering the ICSI cycle can lead to return of fertility in women. In a similar study, Rinbelt et al. showed that embryo quality in these patients was not different with other patients for doing ICSI[12]. Evaluating the quality of embryo in this study also confirmed this finding. … [13, 14].
Suggestions
Non-declared by the authors.
Limitations
Non-declared by the authors.
Conclusions
The rate of ISCI fertility in women after endometriosis treatment is not different from that of healthy women.
Acknowledgments
Non-declared by the authors.
Conflict of interest
Non-declared by the authors.
Ethical Permissions
The details of this study were approved by the ethics committee of the Sarem Women Hospital.
Funding Sources
Non-declared by the authors.

TABLES and CHARTS

Show attach file