In vitro fertilization (IVF) is a time consuming, expensive and difficult procedure that may be the only option for DES daughters to conceive and carry a pregnancy to term (11, 12, 13). Even IVF is no guarantee that you will become pregnant as our review articles show. Your age and your previous difficulties becoming pregnant should not be absolute reasons for IVF to be withheld; however, only you and your obstetrician-gynecologist can make that decision. IVF has successfully helped DES infertile women and it may be the right choice for you after you review the experience that our DES attorney staff has highlighted for your convenience.
Karande et al described the initial experience of in vitro fertilization (IVF) in DES (diethylstilbestrol) exposed women (12). They reported on 46 women with a history of DES associated infertility who underwent a total of 149 stimulation attempts for IVF using a standard protocol. They compared the rates of implantation and eventual ongoing/term pregnancy with a similarly age-matched control group with tubal factor infertility. There was no difference in egg retrieval, a borderline lower clinical pregnancy rate (15.3% vs. 22%) and a significantly lower term/ongoing pregnancy rate per embryo transfer (8% vs. 16%; P = 0.02) and a lower implantation rate (7% vs. 11.2% P < 0.05).Using hysterosalpingography (HSG) in 29 patients, these investigators noted that 81% had a T-shaped uterus, 54% had uterine constrictions, 22% had irregular margins, 19% had a widened lower uterine segment and 15% had uterine hypoplasia. Women with a T-shaped uterus and uterine constrictions on HSG had the poorest outcomes with IVF.
In response to this significant problem of primary infertility in DES exposed women, several investigators have attempted to use IVF. One such study, by Pal et al in 1997 described poor IVF outcomes of DES daughters during the 1990s (13). They described 17 infertile women with a reported history of intrauterine DES exposure who underwent 27 cycles of assisted reproductive technology (ART).
The authors analyzed key endpoints such as implantation and ongoing pregnancy and compared the results in these women to a control group of 20 patients with infertility of unknown cause who also underwent 27 cycles of ART simultaneously. The patients were carefully matched for confounding variables such as age, basal day 3 follicular stimulating (FSH) and estradiol levels and number and quality of transferred embryos. When the data from the two groups were compared, the DES daughters had significantly reduced implantation and pregnancy rates following IVF and embryo transfer despite similar responses to controlled ovarian hyperstimulation (COH).
Specifically, the DES daughters had a clinical pregnancy rate of 11.8% per embryo transfer compared to 40% for the control group which approached, but did not reach statistical significance (P = 0.07) because of the small numbers in the study. The implantation rates, considering only the first attempts at IVF, were 4.2% versus 13.7% for the DES and control groups respectively. DES attorneys absolutely take into account the need for IVF in all DES exposed women who seek legal action for damages.
11. Salle B. et al. Transvaginal Ultrasound Studies of Vascular and Morphological Changes in Uteri Exposed to Diethylstilbestrol In Utero. Human Reproduction. 11; 11: 2531-2536, 1996.
12. Karande V.C. et al. Are Implantation and Pregnancy Outcome Impaired in DES Exposed Women after In Vitro Fertilization and Embryo Transfer? Fertility and Sterility. 54; 2: 287-91, August 1990.
13. Pal L et al. Outcome of IVF in DES-Exposed Daughters: Experience in the 90s. J Assist Reprod. and Genet. 14; 9: 513-7, 1997.