THE IMPACT OF ENDOMETRIOSIS IN IN VITRO FERTILIZATION OUTCOMES

Problem Statement

Endometriosis, a well-known factor impacting fertility, can directly distort tubo-ovarian anatomy or indirectly cause inflammatory and oxidative damage. Consequently, many women try assisted reproductive technology, such as in vitro fertilization (IVF), to improve their chances of pregnancy.

Methods

To investigate the effects of endometriosis on IVF cycles and post-IVF pregnancy outcomes, a retrospective study was conducted at a tertiary center between January 2014 and December 2022. The study included women undergoing IVF with endometriosis as the sole factor causing infertility, and women where the sole factor identified was male infertility. Cycles involving gamete donation were excluded from the analysis.

Results

Out of the 1069 IVF cycles performed, 179 cases met the inclusion criteria. Among them, 51 cases (28%) presented endometriosis as the sole infertility factor, while 128 (72%) experienced male infertility.

Women with endometriosis were slightly younger (35 versus 36 years) and both groups presented a normal body mass index. During the IVF cycle, women with endometriosis tended to have fewer than 5 antral follicles more frequently (58% versus 14%, p<0,001), requiring higher gonadotrophin concentrations during ovarian stimulation (2700 vs 1850 UI, p<0,001). Moreover, a trend to longer stimulation protocols is noted in women with endometriosis (11 versus 9 days, p<0,001).

However, when comparing cases of sole endometriomas (19 out of 51) with the presence of concurrent superficial and/or profound endometriosis, both the primary infertility rate (59% vs 87%, p=0,02) and the number of oocytes retrieved (9 vs 5 oocytes, p=0,01) showed statistical significance.

In cycles with embryo transfer (n=129, 72%), implantation and clinical pregnancy rates were slightly lower in women with endometriosis, but the differences were not statistically significant. Among 37 pregnancies achieved, 28 were singletons and 9 represented multiple pregnancies. Endometriosis did not significantly affect the obstetrical outcomes.

Conclusion

In conclusion, this study suggests that endometriosis negatively impacts the ovarian reserve, leading to a reduced antral follicle count at younger ages. It may also influence the response to IVF cycle stimulation, requiring higher gonadotrophin doses. Due to limitations regarding the sample size, further research is warranted to confirm the impact of endometriosis on obstetric outcomes.