Hormonal Therapies before in vitro fertilization in women with endometriosis: The Minotaur's Labyrinth and the Ariadne's Thread

Antoine Naem, Department of Obstetrics, Gynecology, Gynecologic Oncology and Senology, Bethesda Hospital Duisburg, 47053 Duisburg, Germany; Faculty of Mathematics and Computer Science, University of Bremen, 28359 Bremen, Germany. Electronic address: antoine.naem@gmail.com.
Harald Krentel, Department of Obstetrics, Gynecology, Gynecologic Oncology and Senology, Bethesda Hospital Duisburg, 47053 Duisburg, Germany.
Gaby Moawad, Department of Obstetrics and Gynecology, George Washington University, Washington, DC 20037, USA; The Center for Endometriosis and Advanced Pelvic Surgery, Washington, DC 22101, USA.
Joelle Naem, Faculty of Medicine of Damascus University, Damascus, Syria.
Renato Venezia, Unit of Obstetrics and Gynecology, "Paolo Giaccone" Hospital, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy.
Andrea Etrusco, Unit of Obstetrics and Gynecology, "Paolo Giaccone" Hospital, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy.
Sanja Terzic, Department of Medicine, School of Medicine, Nazarbayev University, Zhanybek-Kerey Khans Street 5/1, Astana 010000, Kazakhstan.
Antonio Simone Laganà, Unit of Obstetrics and Gynecology, "Paolo Giaccone" Hospital, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy.

Document Type

Journal Article

Publication Date

5-8-2024

Journal

Best practice & research. Clinical obstetrics & gynaecology

DOI

10.1016/j.bpobgyn.2024.102500

Keywords

Aromatase inhibitors; Dienogest; Endometriosis; GnRH agonists; In vitro fertilization; Infertility

Abstract

Endometriosis-related infertility is one of the most debated topics in reproductive medicine. In recent years, prolonged pre-cycle hormonal regimens gained attention as a mean of improving the assisted reproduction technologies (ART) success rates in endometriosis patients. GnRH agonists, dienogest, medroxyprogesterone acetate, and aromatase inhibitors are the most studied medications. Conflicting results and a high risk of bias exist in almost all of the conducted studies in the field. However, current evidence suggests that pre-cycle treatment with GnRH agonists may be beneficial for patients with stage III/IV endometriosis. Dienogest and medroxyprogesterone acetate-based progestin-primed ovarian stimulation protocol was shown to be comparable to the prolonged GnRH agonists protocol. Finally, aromatase inhibitors seem to be of limited benefit to the assisted reproductive outcomes of endometriosis patients. Although it is challenging to draw any clinical conclusions, pre-cycle hormonal treatments seem to be best indicated in endometriosis patients who had previously failed ART treatment.

Department

Obstetrics and Gynecology

Link to Full Text

Share

COinS