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Does endometriosis effect implantation?

Does endometriosis effect implantation? . Bilgin GURATES, MD. IMPLANTATION IS OR IS NOT AFFECTED BY ENDOMETRIOSIS. It’s a common disease and an enigmatic disease. Thi s database gives us the dimension of this problem, which is a huge problem, .

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Does endometriosis effect implantation?

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  1. Does endometriosis effect implantation? Bilgin GURATES, MD

  2. IMPLANTATION IS OR IS NOT AFFECTED BY ENDOMETRIOSIS • It’s a common disease and an enigmatic disease • This database gives us the dimension of this problem, which is a huge problem, • Many different experimental moldels, even animal models, that show that, this disease decreses fertility.

  3. THE MECHANISM OF INFERTILITY • Altered folliculogenesis, • Ovulatory dysfunction, • Hyperprolactinemia, • Luteal phase defect, • Accelerated ovumtransport, • Sperm phagocytosis, • Impaired fertilization, • Embryotoxicity againstearly embryonic development, • Defective implantation

  4. IMPLANTATION • Embryo quality, • This is a high indicator of how pregnancy rates can be more or less. • Endometrial receptivity, • Which is a crucial event. • Transfer efficiency, • That it is actually very important step in the implantation rate. control of hyper stimulation

  5. Presence of Endometriosis Decreases PregnancyRates • Padigas K, Fertil Steril 1996 • Kodama H, Fertil Steril 1996 • Guzick DS, Fertil Steril 1994 • Adamson GD, SeminReprod Endocrinol 1997 • Tummon IS, Fertil Steril 1997 • Falcone T, Curr Opin Obstet Gynecol 1996 • Lu PY, Mayo Clinic Proc1995 • Without • assisted reproductive technologies or • with ovulation induction

  6. ENDOMETRIOSIS &FERTILITY(IVF) SAME WORSE • GEBER, S.,1995. Hum. Reprod. • JONES, H.W., 1984. Fertil. Steril • OLIVENNES, F., 1995. Fertil. Steril. • OEHNINGER, S., 1988. J. InVitroFertil. • FIVNAT (French In Vitro National): French national IVF registry: analysis of 1986 to1990 data. 1993. Fertil. Steril. • MAHADEVANM.M., 1983. Fertil. Steril • WARDLE, P.G., 1986. Lancet • WARDLE, P.G.,1985. Lancet • YOVICH, J.L., 1985, Lancet • MATSON, P.L., 1986.Fertil. Steril. • O’SHEA, R.T., 1985. Lancet • PAL, L., 1998. J. Assist.Reprod. Genet. • ARICI , A., 1996. Fertil. Steril

  7. Impact of ovarian endometrioma on oocytes andpregnancy outcome in in vitro fertilization Endometriosis L/S aspirated tubal factor Takahiro Suzuki, Fertility and Sterility 2005

  8. Effect of endometriosis on in vitrofertilization Christos Coutifaris,

  9. Effect of endometriosis on in vitrofertilization Christos Coutifaris,

  10. Effect of endometriosis on in vitrofertilization Christos Coutifaris,

  11. Impaired parameters • Number of oocytes retrieved, • Peak E2 concentration, • Fertilizationrate, • PR, and • IR Poor oocyte quality Defective implantation capacity

  12. ENDOMETRIAL RECEPTIVENESS • Theoretically, endometriosis might affect endometrial receptivenessby altering the • local biochemical environment • paracrine • endocrine • immune response.

  13. ENDOMETRIOSIS IN OOCYTE RECIPIENTS • Simon C, Gutierrez A, Vidal A, de los Santos MJ, Tarın JJ, Remohı J,et al. Outcome of patients with endometriosis in assisted reproduction:results from in-vitro fertilization and oocyte donation. Hum Reprod1994;9:725–9. • Sung L, Mukherjee T, Takeshige T, Bustillo M, Copperman A. Endometriosisis not detrimental to embryo implantation in oocyte recipients.J Assist Reprod Genet 1997;14:152–6. • Dıaz I, Navarro J, Blasco L, Simon C, Pellicer A, Remohı J. Impact ofstage III–IV endometriosis on recipients of sibling oocytes: matchedcase-control study. Fertil Steril 2000;74:31–4.

  14. OOCYTE DONATION IN PATIENTS WITH ENDOMETRIOSIS n=178 retrospective low response (n = 77) endometriosis (n = 10) premature ovarian failure (n = 54), No differencepregnancy rate per woman, per cycle, per implantation. SIMÓN, C. 1994. Hum. Reprod.

  15. OOCYTE DONATION IN PATIENTS WITH ENDOMETRIOSIS 239 oocyte recipient retrospective without endometriosis (n = 184). Endometriosis ( n = 55) pregnancy rates (28 versus 29%) implantation rates (12 and 13%) Sung L,.J Assist Reprod Genet 1997

  16. Impact of stage III–IV endometriosis onrecipients of siblingoocytes: matchedcase-control study N=25 stage III–IV endometriosis (n=25) Healthy recipient (n =33) Israel Dı´az,Fertility and Sterility 2000

  17. IVF IN PATIENTS WITH ENDOMETRIOSIS Pregnancy rate per cycle (34.4%vs. 12.5% ; p<0.0004) Pregnancy per transfer (37.3%vs. 15.1% ; p <0.002) Implantation rate (13.4%vs. 5.8%; p <0.003) Decreases Number of blastomeres Arrested embryos 78 women 59 women Infertility outcome comparing endometriosis and tubal infertility. SIMÓN, C., A. GUTIERREZ, A. VIDAL, et al. 1994. Outcome of patients with endometriosisin assisted reproduction: results from in vitro fertilization and oocyte donation. Hum. Reprod. 9: 725–729

  18. Simon C,Hum Reprod 1994, Sung L, J Assist Reprod Genet 1997, Dıaz I,Fertil Steril 2000

  19. OOCYTE DONATION IN PATIENTS WITH ENDOMETRIOSIS Grup 1(n=44) Grup 11(n=14) Grup 111(n=16) ENDO(-) ENDO(-) ENDO(+) DONORS ENDO(+) ENDO(-) ENDO(-) RECIPIENTS 60 % 61.4 % 28.6 % Preg Rate Per Tansfer Pellicer, 1994

  20. Follicular-oocyte-embryo quality in endometriosis • Ovlatory dysfonction (Tummon 1988) • Pituitary-ovarian axis (Chaill 1995) • Over production of progesterone (Pellicer 1998) • IL-6 IL-1β, VEGF (Pellicer 1998) • Apoptosis (Toya 2000) • PGF2 (Bergqvist 1997) • MIS (Fallat 1997) • Inhibins A ,inhibins B, activin B (Akande 2000) • Endothelin-1 , (Abea 1994)

  21. Conclusions • Clinic evidence using the oocyte donation model strongly suggest that the endometrium is NOT altered in women with endometriosis. • In-vitro studies on the endometrium of endometriosis patients do not support the hypothesis of an altered endometrial environment. • Rather, decrease oocyte /embryo quality seems to be cause of endometriosis related infertility .

  22. Conclusions • None of the alterations described in the in-vitro studies is relevant for endometrial receptiveness. • Endometrial priming protocols used in OD cycles reestablishan adequate uterine cavity environment. • GnRHa restores the normal apoptotic rate.(Imai A, Am J ObstetGynecol 2000) • 3-monthcourse of GnRH-a(Surrey ES,FertilSteril 2002) • Artificial endometrial priming for OD could be beneficialin that down-regulation and the exogenous supply of Eand P(Cunha-Filho JS, J Assist ReprodGenet 2003) • Pinopode formationwith artificial priming has been demonstrated to be normalin these patients(Garcıa-Velasco JA,FertilSteril2001) • A questionthat remains to be answered concerns the endometrialreceptiveness of these patients in natural cycles.

  23. THANK YOU!

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