Combination treatment of preoperative embryo cryopreservation and endoscopic surgery (surgery-ART hybrid therapy) in infertile women with diminished ovarian reserve and uterine myomas or ovarian endometriomas

ABSTRACT Study Objective To analyze the clinical outcomes and predictive factors for the therapeutic effect of combination treatment of preoperative embryo cryopreservation and endoscopic surgery (‘surgery-assisted reproductive technology [ART] hybrid therapy’) in infertile women with diminished ovarian reserve (DOR) with uterine fibroids and/or ovarian endometriomas. Design A retrospective cohort study (Canadian Task Force Classification II-2) Setting Data from all patients who underwent surgery-ART hybrid therapy at Juntendo University Hospital and Sugiyama Clinic from 2014 to 2016 were analyzed retrospectively. We compared women who experienced livebirth (success group) and implantation failure or miscarriage (failure group) after surgery-ART hybrid therapy and evaluate the predictive factors for livebirth. Patients A total of 39 infertile women underwent surgery-ART hybrid therapy with 86 embryo transfer cycles. Interventions All women underwent ART treatment for embryo cryopreservation preoperatively, reproductive surgery and warmed embryos transfer after the postoperative contraceptive interval (surgery-ART hybrid therapy) for women with DOR (anti-Mullerian hormone 40 years) with uterine myomas and/or ovarian endometriomas who required surgery. Results Out of 39 women underwent surgery-ART hybrid therapy, one woman acquired no embryo after oocyte retrieval trials and gave up conceiving, 14 experienced childbirth (success group) and 24 (63.2%) experienced implantation failure or miscarriage (failure group) after surgery-ART hybrid therapy. Women in the success and failure groups were 40 (38-41) and 41.5 (41-42) years old [median (interquartile range)] (p = .0318) and had 2.5 (0.1-8.6) and 1.3 (0.1-4.2) ng/mL serum anti-Mullerian hormone levels [median (range)] (p = .396), respectively. The numbers of preoperative frozen embryos in the success and failure groups were 5.0 (4.0-6.0) and 2.0 (1.0-3.0), respectively (p Conclusion Successful surgery-ART hybrid therapy requires preoperative sufficient age-specific number of frozen embryos, establishment of ART treatment with stable pregnancy outcomes and skillful reproductive surgery and the strong wills of patients and doctors for pregnancy.