DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20210297

Endometriosis and ART outcome: a retrospective analysis

Janani S., Kundavi Shankar, Geetha V., Abdul Basith

Abstract


Background: Endometriosis affects up to 30-40% of women seeking fertility treatment and is known to reduce fecundity. There remains a debate on the effect of endometriosis on the IVF outcome, with live birth not reported in most studies. This study looks at the impact of endometriosis on live birth rates after IVF and compares the chances of success with those without endometriosis.

Methods: Retrospective analysis of women who underwent IVF at our institution for 2 years were included. Multiple factor infertility, ovulation disorders and donor program were excluded. The outcomes were compared for 4 cohorts - women with endometriosis, male factor infertility, tubal factor infertility and unexplained infertility. The primary outcome was live birth rate. Other outcome measures were total dose of gonadotropins used, mean number of oocytes collected, M2 oocyte rate, fertilization rate, implantation rate, and clinical pregnancy rate.

Results: Patients diagnosed with endometriosis had lower mean number of oocytes collected (6.86 vs 7.69, 7.94, 7.45) and lower mean number of M2 oocytes (5.31 vs 6.21, 6.44, 5.91) but was not statistically significant. Endometriosis patients required significantly higher dose of gonadotropins when compared to controls (5365.79 IU;  p-0.001). The per ET implantation rate (10.4% vs 17.8%, 22.5%, 19.2%), clinical pregnancy rate (8% vs 15%, 20%, 17%), live birth rate (7.92% vs 16.6%, 15.14%, 12%) and the cumulative live birth rate (27.9% vs 46.5%, 60%, 46.7%) were significantly less in women with endometriosis (p-0.039, p-0.021, p-0.001, p-0.039 respectively) and the effect is more pronounced with increasing disease severity.

Conclusions: Endometriosis affects all aspects of IVF outcomes including folliculogenesis, embryo development and implantation. Though ovarian factor can be overruled by increasing the stimulation doses as in our study, methods to improve the implantation rates should be thought about in future. 


Keywords


Endometriosis, Implantation rate, Live birth rate, Oocytes rate

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References


Feichtinger M, Nordenhök E, Olofsson JI, Hadziosmanovic N, Wallberg KA. Endometriosis and cumulative live birth rate after fresh and frozen IVF cycles with single embryo transfer in young women: no impact beyond reduced ovarian sensitivity-a case control study. J Assist Reprod Genet. 2019;36(8):1649-1656.

Muteshi CM, Ohuma EO, Child T, Becker CM. The effect of endometriosis on live birth rate and other reproductive outcomes in ART cycles: a cohort study. Human Reproduction Open. 2018;4:2018.

Hanege YB, Çekıç GS, Ata B. Endometrioma and ovarian reserve: effects of endometriomata per se and its surgical treatment on the ovarian reserve. Facts Views Vis Obgyn. 2019;11(2):151-7.

Chiang HJ, Lin PY, Huang FJ. The impact of previous ovarian surgery on ovarian reserve in patients with endometriosis. BMC Womens Health. 2015;15:74.

Sanchez AM, Vanni VS, Bartiromo L. Is the oocyte quality affected by endometriosis? A review of the literature. J Ovarian Res. 2017;10(1):43.

Xu B, Guo N, Zhang XM. Oocyte quality is decreased in women with minimal or mild endometriosis. Sci Rep. 2015;5:10779.