[Effect of gonadotropin-releasing hormone agonist used before surgery on natural pregnancy rates in patients with ovarian endometriomas].
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China.
Objective: To evaluate the impact of gonadotropin-releasing hormone agonist (GnRH-a) used before surgery on natural pregnancy rates in patients with ovarian endometriomas. Methods: In this retrospective study, 57 patients with ovarian endometriomas who had a consecutive laparoscopic surgery between June, 2010 to September, 2015 in Peking Union Medical College Hospital were included. Those patients were divided into preoperative GnRH-a treatment group (n=31) and non-GnRH-a treatment group (n=26) . There were no differences in patients' characteristics between the two groups. All of them had a desire for natural pregnancy postoperatively. GnRH-a was no longer used after surgery. After the surgical procedure, the patients were observed over a period of 12 months, during which the frequency of natural pregnancy was assessed. The two groups were compared in terms of natural pregnancy rates. Results: Totally 33 patients had natural pregnancy after surgery. The univariate analysis showed that the pregnancy rates of age, r-AFS stage, infertility, preoperative use of GnRH-a, tumor size, tumor side, deep infiltrating endometriosis and adenomyosis did not have statistically significant differences (all P>0.05) . The two classified logistic regression showed that OR for preoperative use of GnRH-a was 0.250 (95%CI: 0.064-0.978) with a statistical difference (P=0.046) . Conclusion: The use of GnRH-a preoperatively may have a negative effect on natural pregnancy rates of patients after surgery with ovarian endometriomas.
Endometriosis; Gonadotropin-releasing hormone; Laparoscopy; Pregnancy
Dr. K's Comment:
This study showed that using GnRH agonist (e.g. lupron) for endometriosis before surgery actually have a negative effect on natural pregnancy rates. A woman is four times less likely to spontaneously conceive when GnRH agonist is used before surgery compared to when GnRH agonist is not used. There are perhaps two main reasons for this:
1. Not being in a suppressed state at the time of surgery may allow better visualization of endometriosis and hence a more thorough removal of endometriosis lesions.
2. GnRH agonist may exert a negative effect on fertility in general, likely on the ovarian function.
However a great number of gynecologists and infertility specialists often recommend disease suppression right before endometriosis surgery.
Instead, whenever patients can tolerate it, we prefer that they stop their suppression at least a month prior to surgery and at times we'll even prescribe estrogen for them to take before surgery. This study supports our practice!