January 30, 2006

Hormone Aids Conception in Women with Endometriosis

NEW YORK -- For women with endometriosis who undergo assisted fertilization procedures, treatment with a hormone that decreases the body's production of testosterone and estrogen a few months before the procedure quadruples the chance of successful pregnancy, according to a review of randomized trials -- but data on side effects is lacking.

Endometriosis is a painful condition that occurs when the tissue that normally lines the uterus grows outside the uterus, often in pelvic and abdominal areas were it is not supposed to grow. Endometriosis is a leading cause of infertility -- up to 40 percent of women with this condition are unable to conceive.

Dr. Hassan Sallam, from Alexandria University in Egypt, and colleagues used medical databases and reports from major reproductive medicine meetings to look for studies that used pretreatment with gonadotropin-releasing hormone (GnRH) agonists as a way to improve pregnancy rates in endometriosis patients who underwent in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI).

Three trials with a total of 165 women were included in the analysis, which is published in the online issue of The Cochrane Library.

Women pretreated with a GnRH agonist were 4.28-times more likely to become pregnant than their untreated peers, the report indicates. Moreover, the results of one of the studies indicated a 9.19-fold increase in the live birth rate with use of this strategy.

The effect, if any, of GnRH agonist therapy on miscarriage rates is unclear, because just two of the studies examined this outcome, the authors point out. Similarly, there were insufficient data to reach any conclusions about the impact of this treatment on multiple or ectopic pregnancies, fetal anomalies, or other complications.

The message "from these three trials is that the administration of GnRH agonists for a period of three to six months prior to IVF or ICSI in women with endometriosis increases the odds of pregnancy by more than fourfold," the researchers conclude.

SOURCE: The Cochrane Library, January 25, 2006.