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.