Abstract
Purpose To evaluate whether women with endometriosis have different ovarian reserves and reproductive outcomes when compared with women without this diagnosis undergoing in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI), and to compare the reproductive outcomes between women with and without the diagnosis considering the ovarian reserve assessed by antral follicle count (AFC). Methods This retrospective cohort study evaluated all women who underwent IVF/ICSI in a university hospital in Brazil between January 2011 and December 2012. All patients were followed up until a negative pregnancy test or until the end of the pregnancy. The primary outcomes assessed were number of retrieved oocytes and live birth. Women were divided into two groups according to the diagnosis of endometriosis, and each group was divided again into a group that had AFC ≤ 6 (poor ovarian reserve) and another that had AFC ≥ 7 (normal ovarian reserve). Continuous variables with normal distribution were compared using unpaired t-test, and those without normal distribution, using Mann-Whitney test. Binary data were compared using either Fisher's exact test or Chi-square (χ(2)) test. The significance level was set as p < 0.05. Results 787 women underwent IVF/ICSI (241 of which had endometriosis). Although the mean age has been similar between women with and without the diagnosis of endometriosis (33.8 ± 4 versus 33.7 ± 4.4 years, respectively), poor ovarian reserves were much more common in women with endometriosis (39.8 versus 22.7%). The chance of achieving live birth was similar between women with the diagnosis of endometriosis and those without it (19.1 versus 22.5%), and also when considering only women with a poor ovarian reserve (9.4 versus 8.9%) and only those with a normal ovarian reserve (25.5 versus 26.5%). Conclusions Women diagnosed with endometriosis are more likely to have a poor ovarian reserve; however, their chance of conceiving by IVF/ICSI is similar to the one observed in patients without endometriosis and with a comparable ovarian reserve.
Highlights
Women diagnosed with endometriosis are more likely to have a poor ovarian reserve; their chance of conceiving by in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) is similar to the one observed in patients without endometriosis and with a comparable ovarian reserve
All women were followed until a negative pregnancy test or the end of the pregnancy, with reproductive outcomes analyzed in all cases
The diagnosis of endometriosis was performed by ultrasound in only 30 participants (12.4%); by laparoscopy in 182 of them (75.5%); and by both laparoscopy and ultrasound in 29 subjects (12.0%)
Summary
Subfertility is the inability of achieving a pregnancy after one year of regular, unprotected intercourse. Approximately 15% of women in reproductive age are considered subfertile. Assisted Reproduction Technologies (ARTs), in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI), are frequently used to help subfertile couples to conceive.Endometriosis is one of the most cited causes of subfertility, being much more common in subfertile (25–40%) than in fertile woman (0.5–5.0%). This disease is defined by the presence of endometrial tissue outside the uterine cavity, and the mechanisms through which endometriosis impairs fertility are still unclear. Pelvic adhesions and distortion of pelvic anatomy are associated with subfertility, and are frequently observed in moderate and severe cases of endometriosis. the mechanism underlying minimal or mild endometriosis related to subfertility is unclear, and may be related to impairment of oocyte development, embryogenesis and implantation. The ideal fertility treatment for women with endometriosis is not well established yet, but ART treatments are responsible for the highest success rates.. 15% of women in reproductive age are considered subfertile.. Assisted Reproduction Technologies (ARTs), in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI), are frequently used to help subfertile couples to conceive. Endometriosis is one of the most cited causes of subfertility, being much more common in subfertile (25–40%) than in fertile woman (0.5–5.0%).. Endometriosis is one of the most cited causes of subfertility, being much more common in subfertile (25–40%) than in fertile woman (0.5–5.0%).5 This disease is defined by the presence of endometrial tissue outside the uterine cavity, and the mechanisms through which endometriosis impairs fertility are still unclear.. The mechanism underlying minimal or mild endometriosis related to subfertility is unclear, and may be related to impairment of oocyte development, embryogenesis and implantation..
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