Adenomyosis
The other issue concerning cancellation is the presence of adenomyosis.
We found adenomyosis rate 64% (28/44) in CC group and 40% (16/44) ETC
group and the difference was statistically significant
Nevertheless, it was found that the presence of adenomyosis is not an
independent marker of cycle cancellation in the univariate analysis.
Although it is not an independent factor in terms of cancellation, we
can say that it is important to determine the presence of adenomyosis in
terms of cancellation since it was shown that the AFC is worse in the
presence of adenomyosis (8 (1 – 20) vs. 6 (1 – 16), p<0.01).
This result may be strengthened with larger sample size.
There were 28 cancelled cycles with adenomyosis in our study. 3 (10.7%)
of these cycles were cancelled because of inefficient ovarian response,
16 (57%) of these cycles cancelled because of fertilization problem and
9 (32%) of these cycles cancelled because of maturation problem.
(Table-8)
Although it is not possible to make statistical analysis due to the
small number of cases, it is thought that more than half of the
cancellation cases in the presence of adenomyosis have insufficient
ovarian response and this may be related to ovarian reserve. There is no
data in the literature about how ovarian reserve is affected in the
presence of adenomyosis.
Beyond of all these factors discussed above, we also analyzed whether
endometriosis phenotype is predictive for cycle cancellation. In our
study it was found that the cycle cancellation is mainly based on
ovarian functions and endometriosis phenotype does not affect the cycle
cancellation rates.. Presence of adenomyosis and laparotomy history are
also negative factors both on ovarian reserve and cycle cancellation.
We can predict the risk of cancellation with analyzing ovarian reserve
parameters carefully. Day3 FSH, AMH, AFC are important parameters to
predict cycle success in ERI. AFC is the only independent factor to
predict cycle success. Results can be confirmed with further larger
scale studies.