Endometriosis diagnosed by ultrasound is associated with lower live birth rates in women undergoing their first in vitro fertilization/intracytoplasmic sperm injection treatment

Abstract

ObjectiveTo study the cumulative live birth rate (CLBR) after the first In Vitro Fertilization (IVF) or Intracytoplasmic Sperm Injection (ICSI) treatment in women with or without deep infiltrating endometriosis (DIE) and/or endometrioma diagnosed by transvaginal ultrasonography (TVUS), using the International Deep Endometriosis Analysis (IDEA) group definitions. DesignProspective observational cohort study at a university hospital. SubjectsIn total 1040 subfertile women aged 25- ≤39 years, undergoing their first IVF/ICSI treatment between January 2019 and October 2022. Of these, 234 (22.5%; 95% Confidence Interval (CI), 20.0 – 25.0) women were diagnosed with DIE and/or endometrioma at systematic TVUS prior to starting their treatment. ExposureAll women underwent their first IVF or ICSI treatment. Fresh and/or frozen embryos from the first cycle were used until pregnancy was achieved or no embryos remained. Main Outcome MeasuresCLBR after the first IVF/ICSI cycle in women with or without DIE and/or endometrioma. ResultsThe CLBR after the first IVF/ICSI treatment in the total cohort of women was 426/1040, (41.0%; 95% CI, 38.0 – 44.0). Women with DIE and/or endometrioma had a lower CLBR (78/234, 33.3%; 95% CI, 27.3 – 39.4) compared to women without the disease (348/806, 43.2%; 95% CI, 39.8 – 46.6), p=0.007. The crude relative risk (RR) for cumulative live birth for women with DIE and/or endometrioma was 0.77; 95% CI, 0.63-0.94, and after adjustments were made for age, BMI, s-anti müllerian hormone, stimulation protocol and day for embryo transfer, the adjusted RR was 0.63; 95% CI, 0.48-0.82. There was no difference in the number of retrieved mature oocytes, fertilization rate or good quality embryos between the two groups. ConclusionThe presence of DIE and/or endometrioma diagnosed by TVUS lowers the chance for a live birth in women undergoing their first IVF/ICSI treatment.