Abstract
PurposeTo investigate the impact of symptomatic and surgically confirmed endometriosis on ovarian sensitivity index (OSI) and cumulative live-birth rates (LBR) using predominantly single embryo transfer (SET).MethodsCross-sectional case-control study in a University-based ART program. Women with symptomatic and surgically confirmed endometriosis (N = 172), who underwent IVF/ICSI at Karolinska University Hospital were compared to controls without clinically suspected endometriosis (N = 2585). Two thousand seven hundred fifty-seven patients underwent 8236 treatment cycles (4598 fresh and 3638 frozen cycles). Primary outcome measures included Ovarian Sensitivity Index (OSI) estimated as collected oocytes/FSH dose and cumulative LBR/oocyte pickup (OPU). Generalized estimated equation (GEE) model accounting for dependencies between consecutive treatments were applied. Secondary outcomes included number of oocytes, pregnancy rate per OPU and per ET, LBR per ET, and miscarriage rate.ResultsPatients diagnosed with endometriosis had significantly fewer oocytes collected (8.47 vs. 9.54, p = 0.015) and lower OSI (p = 0.011) than controls. There were no differences in cycle cancelations (p = 0.59) or miscarriages (p = 0.95) between the two groups. Cumulative LBR/OPU did not differ between women with endometriosis and controls (35.6% vs. 34.7%, respectively, p = 0.83). In both groups, more than 60% of women had consecutive FETs after fresh ETs (p = 0.49) with SET in > 70% of cases. The results were similar whether ovarian endometrioma was present or not.ConclusionsOur data support that a diagnosis of endometriosis, with or without present endometrioma, does not negatively affect ART cumulative results. The impact of endometriosis was discernible on OSI but not on clinical relevant outcomes including pregnancy and LBR.
Highlights
Endometriosis is a benign but chronic inflammatory disease affecting around 10% of women of reproductive age with a high prevalence of up to 40% in infertile women [1]
Women with endometriosis did not differ in demographic variables including age (p = 0.91) or BMI (p = 0.81) (Table 1), when compared to controls
In women with endometriosis (n = 172), 38.4% had ovarian endometrioma (n = 66); and in 10.5% of cases (n = 18), endometriosis was associated with additional infertility factors
Summary
Endometriosis is a benign but chronic inflammatory disease affecting around 10% of women of reproductive age with a high prevalence of up to 40% in infertile women [1]. J Assist Reprod Genet (2019) 36:1649–1656 similar to those of controls [2] This data is suggesting a detrimental effect of endometriosis only in combination with other infertility diagnoses, such as concomitant male factor infertility, diminished ovarian reserve, or tubal factor infertility. A meta-analysis has indicated a decrease in oocyte yields and reduced clinical pregnancy rate in patients with endometriosis undergoing IVF, compared to controls; multiple embryos had been replaced in most of the studies and the live-birth rate was similar [3, 4]. The effect of age has been difficult to disentangle in previous studies, as even in young women, the bulk of data on IVF/ICSI outcomes in women with endometriosis is based on treatments using multiple embryos for transfer [2, 7,8,9]
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