Results
Between the years Jan 2012- Jan 2017 there were 2515 cycles. All cycles were screened and 222 of the cycles were enrolled in the study. Demographic data of 222 cycles is presented in Table-2. Median age was 31 (20 – 40) years. Median duration of infertility was 4 (1 -18) years.
There were 18 (8.1%) patients with superficial endometriosis, 157 (70.7%) patients with ovarian endometrioma and 47 (21.2%) patients with deep infiltrating endometriosis.
The presence of history of surgery was 56.7% as 20.6% of was by laparotomy and 79.4%, by laparoscopy.
Median day 3 FSH was 6.7 (2.6 – 23.2) IU/dl, median day 3 E2 was 43 (15 -310) pg/ml and median AMH was 1.9 (0.1 – 10) ng/ml. Median AFC was 7 (1 - 20)
Overall live birth rate was 18% per cycle and 24.6% per embryo transfer. (Table-4)
44 (19.8%) cycles were cancelled and in 178 (80.2%) cycles embryo was able to transferred. (Table-3)
4 (9.1%) cycles due to inefficient response (Type A), 24 (54.6%) cycles due to fertilization failure (Type B) and 16 (36.3%) cycles due to maturation arrest (Type C) were cancelled.
When the groups were compared, age was higher in CC group. (34 (26 – 43) yrs. vs. 30 (8 – 40) yrs. p<0.01)
Day 3 FSH levels were higher in CC group., respectively (8.1 (2.6 – 23.2) IU/dl vs. 6.2 (2.6 – 21.8) IU/dl p<0,01)
AMH level was lower in CC group. (0.5 (0.01 – 10) ng/ml vs. 1.9 (0.01 – 10) ng/ml p<0.01)
AFC was lower in CC group. (4 (1 – 16) vs. 8 (1 – 20) p<0.01)
Presence of adenomyosis was higher in CC group. (64% vs. 40% p<0.01)
Surgery rate with laparotomy was higher in CC group. (54.5% vs. 13.5% p<0.01) (Table-5)
We further analyzed the statistically significantly different factors (p<0.05) with binary logistic regression analysis to determine the independent risk factors that are prognostic for cycle cancellation. AFC (OR:0.81, CI:0.70:0.93) remained as the only independent factor associated with prognoses of IVF cycle. (Table-6)
We analyzed the presence of adenomyosis and presence of surgery history with laparotomy vs. laparoscopy to find whether has negative impact on ovarian reserve. AFC was lower in patients with adenomyosis. (8 (1 – 20) vs 6 (1 – 16), p<0.01) But other ovarian reserve markers (day3 FSH, day3 E2, AMH) were similar in patients with / without adenomyosis. (Table – 9) AFC and AMH levels were lower in patients with laparotomy history than the patients with laparoscopy history. (AFC; 4 (1 – 9) vs 7 (1 – 20), p<0.01 – AMH; 0.2 (0.1 – 10) vs 1.72 (0.1 – 5.2), p:0.02) (Table-10)
Cancellation rates were as 16.6% in SUP, 19.7% in OMA, 21.2% in DE and there was no statistically significant differences between the phenotypes of endometriosis. (Table-7)