Abstract
Endometriosis and infertility are closely linked, but the underlying mechanisms are still poorly understood. This study aimed to evaluate the impact of endometriosis on in vitro fertilization (IVF) parameters, especially on embryo quality and IVF outcomes. A total of 1124 cycles with intracytoplasmic sperm injection were retrospectively evaluated, including 155 cycles with endometriosis and 969 cycles without endometriosis. Women with endometriosis had significantly lower ovarian reserve markers (AMH and AFC), regardless of previous ovarian surgery. Despite receiving significantly higher doses of exogenous gonadotropins, they had significantly fewer oocytes, mature oocytes, embryos, and top-quality embryos than women in the control group. Multivariate analysis did not reveal any association between endometriosis and the proportion of top-quality embryo (OR = 0.87; 95% CI [0.66–1.12]; p = 0.3). The implantation rate and the live birth rate per cycle were comparable between the two groups (p = 0.05), but the cumulative live births rate was significantly lower in in the endometriosis group (32.1% versus 50.7%, p = 0.001), as a consequence of the lower number of frozen embryos. In conclusion, endometriosis lowers the cumulative live birth rates by decreasing the number of embryos available to transfer, but not their quality.
Highlights
Endometriosis is a complex gynecological disease whose pathogenesis is still widely debated
Our study aimed to assess the impact of endometriosis on in vitro fertilization (IVF) outcomes, especially on embryo quality and live birth rates
We found that women with endometriosis had a significantly lower number of oocytes and mature oocytes retrieved despite receiving higher gonadotropins doses, and a significantly lower number of embryos and top-quality embryos
Summary
Endometriosis is a complex gynecological disease whose pathogenesis is still widely debated. Several pathophysiological mechanisms have been proposed to explain the infertility caused by endometriosis, such as pelvic adhesions caused by the lesions, especially those involving the fallopian tubes; pelvic inflammation that could disrupt fertilization and implantation; and an impairment of ovarian function [4,5]. The latter is thought to be linked to a decrease in the ovarian reserve, whether following repeated ovarian surgeries, or as a direct consequence of endometriomas. The aim of this study was to assess the impact of endometriosis on IVF cycles parameters, especially on embryo quality and IVF outcomes
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