Fertility Preservation for Women with Endometriosis. What have we learned from 84 women?

Endometriosis affect 6% to 10% of reproductive-age women. Patients may suffer from a progressive reduction in the ovarian reserve especially if ovarian endometrioma (OMA) is involved. Fertility preservation provides women an opportunity of bearing children in the future using their own gametes.

The aim of this study was to evaluate the outcome of fertility preservation treatments in women with endometriosis. Every woman with definite diagnosis of endometriosis (by histology or US) who underwent fertility preservation treatment in two IVF units between 2016 – 2021 was included. As some women cryopreserved oocytes and embryos, the primary outcome was the number of MII oocyte retrieved.

Results:
84 women with endometriosis underwent 165 fertility preservation cycles. Mean women`s age was 31.9 years. 50/84 (60%) women underwent at least one endometriosis surgery prior to fertility preservation treatment. 39/50 (78%) had ovarian involvement (OMA) during surgery. 21/84 (25%) women cryopreserved oocytes and embryos. Using a multivariate analysis of the first cycle of each woman we have found that women who underwent surgery involving OMA prior to their fertility preservation treatment had a reduction of 51.7% (95% CI, 26.1- 68.5, p=0.001) in the number of MII oocytes compared to women with OMA that were not operated. In addition, operated women had lower AMH levels (1.0 ng/ml vs 2.5, p<0.001), required more gonadotropins during their treatment (4810 IU vs. 3796 IU, p<0.001) and had less retrieved oocytes (7.2 vs 9.6, p=0.01).

Conclusions:
Fertility preservation is recommended prior to endometriosis surgery, especially in cases where OMA is suspected.