Endometriosis doubles odds for miscarriage in patients undergoing IVF or ICSI

Pallacks, Corinna; Hirchenhain, Jens; Krüssel, Jan-Steffen; Fehm, Tanja; Fehr, Daniel

doi:10.1016/j.ejogrb.2017.04.008

Cited by 14 publications

(14 citation statements)

References 39 publications

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“…The rate of miscarriage, defined as the spontaneous interruption of pregnancy before 20 weeks of gestation (106), is often not reported in the studies aiming to investigate outcomes of women affected by DE (47,49,66,73,76,85,93,96,100,(103)(104)(105)111).…”

Section: Miscarriagementioning

confidence: 99%

Obstetrical complications of endometriosis, particularly deep endometriosis

Maggiore

Inversetti

Schimberni

et al. 2017

Fertility and Sterility

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Over the past few years, a new topic in the field of endometriosis has emerged: the potential impact of the disease on pregnancy outcomes. This review aims to summarize in detail the available evidence on the relationship between endometriosis, particularly deep endometriosis (DE), and obstetrical outcomes. Acute complications of DE, such as spontaneous hemoperitoneum, bowel perforation, and uterine rupture, may occur during pregnancy. Although these events represent life-threatening conditions, they are rare and unpredictable. Therefore, the current literature does not support any kind of prophylactic surgery before pregnancy to prevent such complications. Results on the impact of DE on obstetrical outcomes are debatable and characterized by several limitations, including small sample size, lack of adjustment for confounders, lack of adequate control subjects, and other methodologic flaws. For these reasons, it is not possible to draw conclusions on this topic. The strongest evidence shows that DE is associated with higher rates of placenta previa; for other obstetrical outcomes, such as miscarriage, intrauterine growth restriction, preterm birth and hypertensive disorders, results are controversial. Although it is unlikely that surgery of DE may modify the impact of the disease on the course of pregnancy, no study has yet investigated this issue.

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Section: Miscarriagementioning

confidence: 99%

Obstetrical complications of endometriosis, particularly deep endometriosis

Maggiore

Inversetti

Schimberni

et al. 2017

Fertility and Sterility

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“…This phenomenon of P-resistance might account for the unexpectedly high miscarriage rate that we observed in the untreated women suspected endometriosis in this study (Table 2). An appreciation of endometriosis and its effect on miscarriage is limited and deserves more attention [13]. This inflammatory pathway may also account for the poor fertilization rate seen in the untreated controls, compared to the two other treatment groups.…”

Section: Discussionmentioning

confidence: 99%

“…On average, clinical pregnancy rates for women less than 38 years old remain near or below 50% in most centers (www.sart.org), even when normal PGS-defined euploid embryos are transferred [12]. Endometriosis has been shown to double the miscarriage rate in recent studies during IVF in women with known endometriosis [13]. Given the declining use of laparoscopy before IVF, most women with endometriosis entering ART programs do not know they have this disease.…”

Section: Introductionmentioning

confidence: 99%

Medical or surgical treatment before embryo transfer improves outcomes in women with abnormal endometrial BCL6 expression

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Cooper

Efird

et al. 2019

J Assist Reprod Genet

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Purpose To evaluate the effect of medical or surgical treatment prior to embryo transfer in women with elevated endometrial BCL6 expression and suspected endometriosis in a prospective, cohort study design at a university-associated infertility clinic. Methods All subjects had at least 1 year of unexplained infertility (UI) and each prospectively underwent endometrial biopsy and immunostaining for the oncogene BCL6, prior to embryo transfer during an assisted reproductive technology (ART) cycle. To be included, subjects had to have an abnormal BCL6 result, defined by elevated HSCORE ≥ 1.4. Women that were pre-treated with laparoscopy or medical suppression with GnRH agonist (depot leuprolide acetate; Lupron®, Abbvie, Inc., Chicago, IL) for 2 months were compared to a group that went untreated (controls). Endpoints included implantation rate (IR), clinical pregnancy rate (CPR), and live birth rate (LBR), and as well as cycle characteristics. Miscarriage rate were also compared between treatment and control group. Results Women in each group had similar characteristics. Those treated by medical suppression and those undergoing laparoscopy for endometriosis had a significantly higher LBR, (5/10; 50%; 95%CI 23.7 to 76.3%) and (11/21; 52.4%; 95%CI 32.4 to 71.7), respectively, compared to controls (4/54; 7.4%; 95%CI 2.9 to 17.6). An absolute benefit of 44.2% (16/31; 95%CI 24.6 to 61.2) and a number need to treat of 3 for those that received treatment (medical suppression and laparoscopy), compared to no treatment. Miscarriages were significantly more common in the control group. Conclusions Women with suspected endometriosis and aberrant endometrial BCL6 expression have worse reproductive outcomes following embryo transfer, including a high miscarriage rate, poor IR, and low LBR and CPR compared to cycles pretreated with medical and surgical management.

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“…The limited effectiveness of IVF in endometriosis has been supported by other authors as well. Pallacks et al ( 109 ), state that endometriosis reduces the chance of conceiving, even after IVF/ICSI. Surgery for endometriomas alone does not enhance IVF, according to Polat et al ( 110 ).…”

Section: Endometriosis-associated Infertilitymentioning

confidence: 99%

Endometriosis and in vitro fertilisation (Review)

et al. 2018

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The aim of the present review was to discuss a matter of concern in the clinical field of obstetrics/gynecology, namely the potency of in vitro fertilization (IVF) in the management of endometriosis-associated infertility. Endometriosis is a medical condition affecting one tenth of women in their fertile years, and accounts for up to 50% of infertile women. Thus, such high prevalence has established the necessity for investigating the effectiveness of available techniques in eradicating the disease and constraining infertility as well as the accompanying pain symptoms of endometriosis. The underlying mechanisms connecting endometriosis with low fecundity have been extensively studied, both in terms of genetic alterations and epigenetic events that contribute to the manifestation of an infertility phenotype in women with the disease. Several studies have dealt with the impact of IVF in pregnancy rates (PRs) on patients with endometriosis, particularly regarding women who wish to conceive. Results retrieved from studies and meta-analyses depict a diverse pattern of IVF success, underlining the involvement of individual parameters in the configuration of the final outcome. The ultimate decision on undergoing IVF treatment should be based on objective criteria and clinicians' experience, customized according to patients' individual needs.

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Endometriosis doubles odds for miscarriage in patients undergoing IVF or ICSI

Cited by 14 publications

References 39 publications

Obstetrical complications of endometriosis, particularly deep endometriosis

Obstetrical complications of endometriosis, particularly deep endometriosis

Medical or surgical treatment before embryo transfer improves outcomes in women with abnormal endometrial BCL6 expression

Endometriosis and in vitro fertilisation (Review)

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