Severe endometriosis associated with poor IVF outcomes

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1. Women with Stage III/IV endometriosis undergoing in vitro fertilization (IVF) had lower rates of implantation and clinical pregnancy. 

2. Women with Stage I/II endometriosis had lower fertilization rates. 

Evidence Rating Level: 2 (Good) 

Study Rundown: This study found that women with endometriosis experienced a higher incidence of adverse IVF outcomes. Major findings include the observed association between advanced endometriosis (Stage III/IV) and lower rates of implantation and clinical pregnancy. Past studies have suggested that the degree of endometriosis may affect IVF outcomes in a dose-dependent fashion, and the findings of the present work support this. This meta-analysis adds new information to the literature base by including data through 2012 and excluding women who received medical or surgical interventions for endometriosis prior to IVF to achieve a more parsimonious study design.

Strengths of this meta-analysis include a large pooled sample size and evaluation of the methodological quality of included studies. Limitations include heterogeneity across studies, such as the timing of reported IVF outcomes and methods used to diagnose endometriosis. Future studies might compare women who received interventions for endometriosis prior to IVF with those who did not to evaluate whether treatment of endometriosis improves IVF outcomes. 

Click to read the study in the British Journal of Obstetrics & Gynaecology

Relevant Reading: UpToDate: Pathogenesis and treatment of infertility in women with endometriosis

In-Depth [meta-analysis]: This systematic review evaluated the relationship between endometriosis and IVF outcomes. Data was abstracted from 27 observational studies examining IVF outcomes for women with endometriosis (n=1490) and women without endometriosis (n=7494) from 1985 through 2012. Included studies were evaluated for methodological quality using the Newcastle-Ottawa Scale. Outcomes evaluated include fertilization, implantation, clinical pregnancy and live birth rates.

Compared to women undergoing IVF for other indications, women with endometriosis demonstrated poorer IVF outcomes. Women with Stage I/II endometriosis had lower fertilization rates (RR 0.93, CI 0.87-0.99). Women with Stage III/IV endometriosis had lower implantation rates (RR 0.79, CI 0.67-0.93) and clinical pregnancy rates (RR 0.79, CI 0.69-0.91). While it did not reach statistical significance, women with Stage III/IV endometriosis also had a lower live birth rate (RR 0.86, CI 0.68-1.08).

By Denise Pong, MPH and Leah Hawkins, MD, MPH

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