Pretreatment with dienogest in women with endometriosis undergoing IVF after a previous failed cycle
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Pretreatment with dienogest in women 
with endometriosis undergoing IVF after 
a previous failed cycle
 Highlights
• IVF has worse outcomes in patients with endometriosis.
• The prolonged use of hormone drugs before IVF may improve 
pregnancy outcomes.
• Dienogest (DNG) is a progestin with anti-inflammatory and anti-
angiogenic activity.
• Implantation rates may be higher as a result of receiving DNG 
before IVF.
• Clinical pregnancy rates may be higher as a result of receiving DNG 
before IVF.
Abstract
Research question
The major causes of IVF
 failure in women with 
endometriosis have been 
attributed to decreased 
ovarian reserve, low embryo 
quality and impaired 
receptivity of the 
endometrium. Dienogest 
(DNG) has anti-inflammatory 
and anti-angiogenic activity 
and so may theoretically 
improve IVF outcomes in 
women with endometriosis. 
This study aimed to evaluate 
the administration of DNG 
before IVF in women with 
endometriosis who had 
previously failed one IVF 
cycle.
Methods
This study was based 
on the retrospective 
analysis of a 
prospectively 
collected database, 
including 151 women 
who had failed a 
previous IVF cycle 
and all subsequent 
embryo transfers 
and had an imaging 
diagnosis of 
endometriosis. 
Patients either 
directly underwent 
IVF without receiving 
hormonal treatment 
or received 3 months 
of treatment with 
DNG (2 mg/daily) 
before IVF.
Results
Eighty-eight (58.3%) patients 
underwent IVF without previous 
hormonal treatment, and 63 
(41.7%) received pretreatment 
with DNG. The cumulative 
implantation, clinical pregnancy 
and live birth rates were 
significantly higher in the DNG-
treated group (39.7%, 33.3% and 
28.6%) than in the non-treated 
group (23.9%, 18.2% and 14.8%; 
P = 0.049, 0.037 and 0.043, 
respectively). The largest 
diameter of endometriomas 
significantly decreased after DNG 
pretreatment (P < 0.001). The 
use of DNG increased 
significantly the number of 
oocytes retrieved (P = 0.031), 
two-pronuclear embryos (P = 
0.039) and blastocysts (P = 
0.005) in women with 
endometriomas of diameter ≥4 
cm.
Conclusions
This study suggest that in patients with endometriosis, IVF outcomes 
can be improved by pretreatment with DNG. In particular, the use of 
DNG allows for better oocyte retrieval and blastocysts in patients with 
large endometriomas.
Source :- 
https://www.sciencedirect.com/science/article/abs/pii/S14726483203039
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