HIGH-RATES OF PREGNANCY AFTER LONG-TERM DOWN-REGULATION OF WOMEN WITH SEVERE ENDOMETRIOSIS

OBJECTIVE: The purpose of this study was to determine the effects of pituitary down-regulation for several months on the outcome of in vitro fertilization treatment in women with severe endometriosis. STUDY DESIGN: A total of 84 patients with severe endometriosis (grades III and IV) were recruited in a semirandomized prospective study; 69 of these were controls who were given a short protocol with gonadotropin-releasing hormone agonist followed by human menopausal gonadotropin and human chorionic gonadotropin to induce follicular growth. Fifteen treated patients underwent down-regulation for 2 to 7 months and then human menopausal gonadotropin and human chorionic gonadotropin to induce follicular growth. Twenty nonpregnant controls after in vitro fertilization were treated in a similar manner. RESULTS: The pregnancy rates were much high per embryo transfer, 18 of 42 (42.8%), especially in patients in whom in vitro fertilization was carried out during the fourth month of down-regulation. Pregnancy rates in the control group were 17 of 134 (12.7%) (p < 0.001). CONCLUSION: Higher rates of pregnancy are achieved after in vitro fertilization that follows long-term down-regulation in women with extensive endometriosis.