Endometriosis does not impact live birth rates in frozen embryo transfer (FET) of euploid blastocysts

Abstract

One explanation proposed for subfertility among women with endometriosis is impaired endometrial receptivity. We sought to test this hypothesis by comparing pregnancy and live birth (LB) outcomes in women with endometriosis versus two control groups without suspected endometrial factor: (1) non-infertile patients who underwent ART in order to test embryos for a single gene disorder and (2) couples with isolated male factor infertility. Retrospective Cohort. FETs of PGT-A normal blastocysts performed from January 2016 through March 2018 were included in the analysis. Patients with endometriosis were compared to those with male factor infertility and non-infertile patients using PGT-M for a single gene disorder. Endometriosis was confirmed surgically in 90% of the endometriosis cohort. Patients with multiple infertility diagnoses and those using gestational carriers or donor oocyte were excluded from the analysis. All blastocysts vitrified and warmed for transfer were grade BB or better. Comparisons were made with multigroup chi-square and P<0.05 was considered statistically significant. 472 euploid FET cycles were available for analysis. 59 transfers occurred in patients with endometriosis, 362 transfers in patients with male factor infertility, and 51 transfers in non-infertile patients. There was no difference in patient age in each treatment group and age was not associated with live birth in euploid embryo transfers. An equal number of embryos were transferred in each group. Patients with endometriosis had similar rates of clinical pregnancy (CP) and spontaneous abortion (SAB) when compared to male factor and non-infertile patients. There was no difference in LB in patients with endometriosis (63%) compared to patients with male factor (51%) and non-infertile patients (53%). While the study was only powered to detect a 20% decrease in LB, the 63% LB rate in endometriosis patients did not suggest a negative effect.Tabled 1Endometriosis (n = 59)Male Factor (n = 362)PGT-M (n = 51)P valueNo. Embryos Transferred1.051.091.060.97Positive hCG80%74%80%0.44CP73%65%63%0.43SAB10%14%10%0.63LB63%53%51%0.34 Open table in a new tab Whether endometriosis primarily affects IVF outcomes via oocyte quality or the endometrium is debated. By controlling for embryo quality using euploid FET cycles, we found no difference in pregnancy outcomes in patients with endometriosis compared to those with male factor and non-infertile patients.