Oocyte vitrification for fertility preservation in women with endometriosis: an observational study
Fertility preservation is successful in patients with endometriosis. Patients aged 35 years should consider fertility preservation before surgery, because the IVF outcome can be compromised in young patients who have undergone surgery.
Volume 113, Issue 4, Pages 836–844
Ana Cobo, Ph.D., Juan Giles, M.D., Stefania Paolelli, M.D., Antonio Pellicer, M.D., José Remohí, M.D., Juan Antonio García-Velasco, M.D.
To describe the outcome of fertility preservation (FP) using vitrified oocytes in patients with endometriosis and to determine the impact of ovarian surgery.
Retrospective observational study.
University-affiliated private in vitro fertilization (IVF) center.
Four hundred and eighty-five women with endometriosis who underwent FP from January 2007 to July 2018.
Vitrification of metaphase II (MII) oocytes for future use.
Main Outcome Measure(s)
Oocyte survival rate and cumulative live-birth rate (CLBR).
Mean age at vitrification was 35.7 ± 3.7 years. The women undergoing operations were younger than the nonsurgical patients (33.4 ± 3.6 years vs. 36.7 ± 3.7 years). The survival rate and CLBR were 83.2% and 46.4%, respectively. The number of vitrified oocytes per cycle (6.2 ± 5.8) was higher for the nonsurgical patients compared with the unilateral (5.0 ± 4.5) or bilateral (4.5 ± 4.4) surgery groups, but was comparable among the surgical patients. The effect of age (adjusted odds ratio [OR] 0.904; 95% CI, 0.858–0.952), number of oocytes (adjusted OR 1.050; 95% CI, 1.025–1.091), and survival (adjusted OR 1.011; 95% CI, 1.001–1.020) on the CLBR was confirmed. However, the effect of surgery was not observed (adjusted OR 1.142; 95% CI, 0.778–1.677). Nonetheless, the ovarian response (vitrified oocytes = 8.6 ± 6.9 vs. 5.1 ± 4.8) and CLBR (72.5% vs. 52.8%) were higher in young (≤35 years) nonsurgical patient versus the surgical patients; older women showed similar outcomes.
Fertility preservation gives patients with endometriosis a valid treatment option to help them increase their reproductive chances. We suggest performing surgery after ovarian stimulation for FP in young women. In older women, an individualized treatment should be considered.