Is the endometriosis recurrence rate increased after ovarian hyperstimulation?

ObjectiveTo test the hypothesis that the cumulative endometriosis recurrence rate (CERR) after fertility surgery for endometriosis stage III or IV is increased in women exposed to very high E2 levels during ovarian hyperstimulation (OH) for IVF when compared with women exposed to less high E2 levels during OH for intrauterine insemination (IUI).DesignRetrospective cohort study including infertility patients with endometriosis stage III or IV.SettingLeuven University Fertility Center, between 1990 and 2001.Patient(s)Patients (n = 67) with endometriosis stage III (n = 45) or IV (n = 22) who underwent pelvic reconstructive surgery and subsequently started fertility treatment with either IVF only (n = 39), both IVF and IUI in different cycles (n = 11), or IUI only (n = 17).Intervention(s)Life table analysis was used to calculate the CERR.Main Outcome Measure(s)The CERR based on histologic or cytologic proof of disease recurrence.Result(s)At 21 months after the start of OH the overall CERR was 31% and was significantly lower in patients treated with IVF only (7%) or women treated with both IVF and IUI in different cycles (43 %) than in those treated with IUI only (70%). At 36 months after the start of OH, the overall CERR was 63%.Conclusion(s)In contrast to our hypothesis, the results from this study showed that the CERR is lower after ovarian hyperstimulation for IVF than after lower-dose ovarian stimulation for IUI, suggesting that temporary exposure to very high E2 levels in women during OH for IVF is not a major risk factor for endometriosis recurrence in women treated with assisted reproductive technology.