Does moderate to severe endometriosis have an impact on cumulative live birth rates and in vitro fertilization outcomes?
In our retrospective matched cohort study, women with moderate to severe endometriosis undergoing in vitro fertilization or intracytoplasmic sperm injection treatment from January 2015 to December 2020, were matched 1:2 to women with other etiologies of infertility. Our main outcome was the cumulative live birth rate per cycle and per woman, and secondary outcomes were the number of oocytes retrieved and number of mature oocytes, fertilization rate, total number of embryos and usable embryos, implantation rate, pregnancy rate, miscarriage rate per cycle.
A total of 195 women with endometriosis were matched with 390 women without endometriosis representing 323 and 646 cycles respectively. Women with endometriosis had significantly fewer oocytes retrieved than women in the control group, despite higher doses of gonadotropins, but a similar number of mature oocytes, fertilization rate, total number of embryos and usable embryos. Cumulative live birth rate per cycle and per women were not significantly different between both groups (19.8% vs. 24.1%, p = 0.13 and 32.3% vs. 37.2%, p = 0.24 respectively). In women with endometrioma, a history of cystectomy did not impact the cumulative live birth rate per cycle (28.3% vs. 31.9%, p = 0.68). Tobacco use does not have a worse impact when associated with endometriosis compared to the control group (16.4% vs. 25.9%, p = 0.13).
After excluding bias of confusion thanks to a matched cohort study, we did not observe a significant impact of moderate to severe endometriosis on the in vitro fertilization cumulative live birth rate. Our data are reassuring for the counselling of infertile women with endometriosis before in vitro fertilization.
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My name is Appoline Zimmermann and I am a French MD in gynaecology specialising in reproductive medicine. I recently graduated from the University of Aix-Marseille and am currently working at the Center for Reproductive Medicine, Aix-Marseille University Hospital.
Accepted: February 23, 2023
Received in revised form: February 3, 2023
Received: November 21, 2022
Publication stageIn Press Journal Pre-Proof
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