Department of Obstetrics and Gynecology, Yamaguchi University Graduate School of Medicine, Minamikogushi 1-1-1, Ube, 755-8505, Japan.
Center for Reproductive Medicine, Sendai ART Clinic, Nakakecho 206-13, Miyagino-ku, Sendai, 983-0864, Japan.
J Ovarian Res. 2019 Dec 12;12(1):123. doi: 10.1186/s13048-019-0597-y.
Endometriosis is considered to be the most intractable cause of female infertility. Administering any type of treatment for endometriosis before in vitro fertilization and embryo transfer (IVF-ET) is an important strategy for improving the IVF-ET outcomes for infertile women with endometriosis. In fact, treatment with a gonadotropin-releasing hormone (GnRH) agonist just before IVF-ET has been reported to improve the clinical outcome in endometriosis patients. However, the benefit of Dienogest (DNG), a synthetic progestin, treatment just before IVF-ET remains unclear.
Sixty-eight infertile women with Stage III or IV endometriosis (ovarian endometrial cyst < 4 cm) were recruited for this study. The subjects were divided into 2 groups: a DNG group (n = 33) and a control group (n = 35). DNG was administered orally every day for 12 weeks prior to the conventional IVF-ET cycle in the DNG group. Standard controlled ovarian hyperstimulation with the GnRH agonist long protocol was performed in the control group. The numbers of mature follicles and retrieved oocytes, fertilization rates, implantation rates, and clinical pregnancy rate were compared between the two groups. In addition, the concentrations of inflammatory cytokines, oxidative stress markers, and antioxidants in follicular fluids were also measured.
The numbers of growing follicles, retrieved oocytes, fertilized oocytes, and blastocysts were significantly lower in the DNG group than in the control group. The fertilization and blastocyst rates were also lower in the DNG group than in the control group. Although there was no significant difference in the implantation rate between the groups, the cumulative pregnancy rate and live birth rate were lower in the DNG group than in the control group. There was no significant difference in the abortion rate. Our results failed to show that DNG reduces the inflammatory cytokine levels and oxidative stress in follicular fluids.
Administering DNG treatment just before IVF-ET did not provide any benefits to improve the clinical outcomes for infertile women with endometriosis.
子宫内膜异位症被认为是女性不孕的最棘手原因。在体外受精和胚胎移植（IVF-ET）之前对任何类型的子宫内膜异位症进行治疗是改善子宫内膜异位症不孕妇女 IVF-ET 结局的重要策略。事实上，在 IVF-ET 之前使用促性腺激素释放激素（GnRH）激动剂进行治疗已被报道可改善子宫内膜异位症患者的临床结局。然而，Dienogest（DNG）治疗的益处，一种合成孕激素，在 IVF-ET 之前仍然不清楚。
本研究招募了 68 名患有 III 期或 IV 期子宫内膜异位症（卵巢子宫内膜囊肿 <4cm）的不孕妇女。将受试者分为 2 组：DNG 组（n=33）和对照组（n=35）。DNG 组在常规 IVF-ET 周期前每天口服 DNG 治疗 12 周。对照组采用 GnRH 激动剂长方案进行标准控制性卵巢过度刺激。比较两组的成熟卵泡数和获卵数、受精率、着床率和临床妊娠率。此外，还测量了卵泡液中炎症细胞因子、氧化应激标志物和抗氧化剂的浓度。
DNG 组的生长卵泡数、获卵数、受精卵数和囊胚数明显低于对照组。DNG 组的受精率和囊胚率也低于对照组。尽管两组的着床率无显著差异，但 DNG 组的累积妊娠率和活产率均低于对照组。两组的流产率无显著差异。我们的结果表明，DNG 并未降低卵泡液中的炎症细胞因子水平和氧化应激。
在 IVF-ET 之前给予 DNG 治疗并不能为子宫内膜异位症不孕妇女提供任何改善临床结局的益处。
