RCOG World Congress 2025

Comparing IVF treatment protocols for women with endometriosis and/or adenomyosis

Helena Sinjan, Dr Tulay Karasu

University of Cambridge, Cambridge IVF, Cambridge University Hospitals

(E-mail: hs771@cam.ac.uk)

Introduction

Several studies have looked at comparing different IVF/ICSI treatment protocols for women with endometriosis or adenomyosis, but there is still no clear answer as to which is most effective1,2. This service improvement study in a single centre compared the outcomes of women with endometriosis/adenomyosis following different treatment (Tx) regimes, looking at oocyte collection, blastocyst development and clinical pregnancy rates.

Methods

•June 2021- February 2024: 86 treatment cycles started in 48 women with endometriosis and/or adenomyosis

•63 of these included an embryo transfer (ET)

•Long protocol gonadotropin-releasing hormone (GnRH) agonist or GnRH antagonist protocol for ovarian stimulation

•Blastocysts were transferred fresh or frozen for future ET

•Frozen embryo transfer (FET) cycles were either on medicated or ‘natural’ (without medication) treatment protocols

•Data collected from lab & clinical notes

•Appropriate statistical tests used to analyse outcomes, using GraphPad3

•α = 0.05 (p<0.05 considered significant)

Conclusions

•Factors such as BMI, age and AMH were similar across Tx groups

•AMH significantly positively correlated to both the number of follicles and the number of eggs collected

•GnRH antagonist cycle may lead to higher mean total number of blastocysts compared to a GnRH agonist cycle

•Clinical pregnancy rates similar across all treatment groups after ET

•Cumulative clinical pregnancy rate may be higher in the GnRH antagonist group than in the long protocol GnRH agonist group

•A suitable treatment option could be GnRH antagonist freeze-all-embryos protocol, followed by FET agonist treatment protocol1

Limitations

•Further service evaluation/study required

•Limited by sample sizes, incomplete data set, and lack of information recorded on stage of endometriosis

References

1. Chen Q, Du S, Lin Y, Zheng B. Controlled ovarian stimulation for endometriosis patients with ultra-long GnRH-agonist or GnRH-antagonist protocols: A retrospective study by propensity score matching. J Obstet Gynaecol Res [Internet]. 2023;49(5):1366–74. Available from: http://dx.doi.org/10.1111/jog.15570

2. Goyri E, Kohls G, Garcia-Velasco J. IVF stimulation protocols and outcomes in women with endometriosis. Best Pract Res Clin Obstet Gynaecol [Internet]. 2024;92(102429):102429. Available from: http://dx.doi.org/10.1016/j.bpobgyn.2023.102429

3. GraphPad software [Internet]. Graphpad.com. Available from: https://www.graphpad.com/quickcalcs/

RCOG World Congress 2025

Comparing IVF treatment protocols for women with endometriosis and/or adenomyosis

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