Endometriosis Is Not Associated with Inferior Pregnancy Rates in in vitro Fertilization: An Analysis of 616 Patients

Abstract

Background/Aims: To analyze whether the presence of endometriosis per se is associated with inferior pregnancy rates in women undergoing in vitro fertilization (IVF). Methods: Between July 2005 and November 2012, a total of 485 patients with endometriosis under the age of 38 years undergoing their first IVF attempt at our center were included; 72 patients had minimal-mild disease and the remaining 413 patients had moderate-severe disease. 131 patients with laparoscopically confirmed tubal factor infertility not harboring endometriosis and hydrosalpinx under the age of 38 years undergoing their first IVF attempt at our center served as the control group. Results: The bilateral antral follicle count and controlled ovarian hyperstimulation response were diminished in the moderate-severe group. However, the implantation, clinical pregnancy, miscarriage and live birth rates were comparable among the three groups. The recurrence of endometrioma following pre-IVF cystectomy was not associated with inferior pregnancy rates. Female age, bilateral antral follicle count and number of embryos transferred were noted to be significant independent predictors of live birth. Conclusion: We conclude that neither the presence nor the extent of endometriosis have any detrimental effect on IVF pregnancy rates.

Endometriosis Lowers the Cumulative Live Birth Rates in IVF by Decreasing the Number of Embryos but Not Their Quality

“…We also found a significantly lower number of oocytes retrieved and mature oocytes in women with endometriosis, despite the higher gonadotropin doses used. This is in accordance with the available literature and is explained by the lower ovarian reserve in these patients [7][8][9][10][11][12]56]. Another added factor that could contribute to the lower oocyte yield is the difficult access to the follicles during retrievals in the presence of large endometriomas [57].…”

“…Despite having a significant decrease in the quantitative IVF parameters assessed, we did not find any detrimental impact of endometriosis on oocyte maturity rate and cleavage rate, and multivariate analysis did not show any association between endometriosis and embryo quality. Our findings on the embryo quality are in accordance with several reports [11,16,30,[59][60][61][62][63][64][65] but contradictory to many others [10,13,[66][67][68][69]. The available data regarding time-lapse morphokinetic parameters are also heterogeneous.…”

“…Focal loss of follicular density may cause dysregulation of folliculogenesis, with increased recruitment and atresia acting in a vicious circle, leading to a loss of the follicular capital, resulting in an overall decline in ovarian reserve. The negative effect of endometriosis on ovarian reserve and response to controlled ovarian stimulation (COS) for in vitro fertilization (IVF) has been shown by different studies [7][8][9][10][11][12], but the impact of endometriosis on the oocyte and embryo quality is still debated [13][14][15][16]. In this context, the aim of this study was to assess the impact of endometriosis on IVF cycles parameters, especially on embryo quality and IVF outcomes.…”

Factors associated with a poor prognosis for the IVF-ICSI live birth rate in women with rAFS stage III and IV endometriosis

“…In our study, we had a good cumulative pregnancy rate and LBR in IVF. This is similar to the study of Polat et al (2014) [10], who concluded that women with endometriosis, regardless of the stage of the disease and its extent, had an IVF pregnancy rate and an IVF LBR equivalent to those of women with tubal infertility without endometriosis. We found three factors that significantly affected LBR after IVF-ICSI in women with rAFS stage III and IV endometriosis: active smoking, POR, and rAFS stage IV.…”

Oocyte competence in in vitro fertilization and intracytoplasmic sperm injection patients suffering from endometriosis and its possible association with subsequent treatment outcome: a matched case–control study

“…The suggested effect of endometriosis on pregnancy loss (33) could not be confirmed in our research. In contrast, the work of others was supported who published no such correlation between miscarriage rate and the presence of endometriosis (34,35). However, it has to be kept in mind that both miscarriage and malformation rate in the endometriosis cohort were markedly increased (although not to a significant level).…”