Esmya Versus Surgery Before IVF/ICSI
关键词
抽象
描述
Uterine fibroids are the most common benign uterine tumors in women of reproductive age. Symptoms are depending on size, number and localisation of the fibroids. Heavy menstrual bleeding, anaemia, abdominal pain, dyspareunia and urinary symptoms are often put forward.
Intramural and especially submucous myomas are known to decrease fertility and augment miscarriage rate. Some studies have demonstrated a negative effect of intramural fibroids on fertility outcome, while others do not. A recent meta-analysis found adverse pregnancy outcomes associated not only with submucous and intramural fibroids distorting the uterine cavity, but also with intramural fibroids not distorting the cavity.
Ulipristalacetate (Esmya®) is currently used to pre-treat symptomatic women with fibroids before surgical intervention. Esmya® has been demonstrated to be safe and effective in the treatment of fibroids. Due to apoptosis sometimes a reduction in volume of the myoma is seen. This effect could influence the fertility and operative outcome.
Current options are available before assisted reproductive technology (ART) for infertile women diagnosed with fibroids:
1. no treatment
2. medical pre-treatment before ART:
1. with gonadotropin-releasing hormone (GnRH)-analogues followed by controlled ovarian stimulation
2. with ESMYA followed by controlled ovarian stimulation
3. surgical treatment after medical pre-treatment before ART:
1. after pre-treatment with GnRH analogues followed by myomectomy
2. after ESMYA followed by myomectomy
4. surgical treatment without medical pre-treatment
In our tertiary infertility centre, at the discretion of the physician, as well ESMYA treatment solely or surgery before starting an IVF/ICSI treatment in women with intramural fibroids are often used. Is there a difference in ongoing pregnancy rate after IVF/ICSI in these patients?
Objective of the study Prospective and retrospective gathering of information regarding the efficacy of IVF/ICSI treatment (ongoing pregnancy rates) in patients undergoing medical or surgical treatment preceding their IVF/ICSI treatment in case of diagnosis of intramural fibroids. Especially ongoing pregnancy rates between patients receiving the ESMYA solely treatment and patients pre-treated by myomectomy before IVF/ICSI will be studied once sufficient data have been collected to deduce valuable study results.
日期
| 最后验证: | 06/30/2019 |
| 首次提交: | 07/14/2019 |
| 提交的预估入学人数: | 07/21/2019 |
| 首次发布: | 07/22/2019 |
| 上次提交的更新: | 07/21/2019 |
| 最近更新发布: | 07/22/2019 |
| 实际学习开始日期: | 12/31/2015 |
| 预计主要完成日期: | 12/30/2021 |
| 预计完成日期: | 05/31/2022 |
状况或疾病
干预/治疗
Drug: Ulipristalacetate group
相
手臂组
| 臂 | 干预/治疗 |
|---|---|
| Surgery group patients treated by surgery before starting the IVF/ICSI treatment | |
| Ulipristalacetate group patients treated by ulipristalacetate before starting IVF/ICSI treatment | Drug: Ulipristalacetate group use of ulipristalacetate OR surgery before fertility treatment |
资格标准
| 有资格学习的年龄 | 18 Years 至 18 Years |
| 有资格学习的性别 | Female |
| 取样方式 | Non-Probability Sample |
| 接受健康志愿者 | 是 |
| 标准 | Inclusion Criteria: - 1st, 2nd or 3th IVF/ICSI attempt - infertility Indications: - unexplained - tubal - male/donor sperm - endometriosis I/II - Body Mass Index (BMI) >18 - < 30 - Basal Follicle Stimulating Hormone (FSH) < 10 IU/L - anti-mullerian hormone (AMH) > 1 ng/ml - Normal ultrasound apart from the following: - Type 2 fibroid : ≤2cm diameter - Type 3 - 5 fibroids: with diameter ≥ 3 and ≤10cm according to classification of European Society for Gynecological Endoscopy (ESGE ) Exclusion Criteria: - More than 2 submucous fibroids - Poor responders - Severe male factor |
结果
主要结果指标
1. ongoing pregnancy rates [2 years]
次要成果指标
1. Miscarriage rate [2 years]
2. Time to pregnancy [2 years]
3. Obstetric outcome described as live birth [2 years]
