Similar pregnancy rates with IVF for women with vs. without endometriosis

Key takeaways:

• Pregnancy rates between women with and without endometriosis were not significantly different after IVF.
• Women with more severe stages of endometriosis had lower cumulative pregnancy rates vs. other groups.

Pregnancy rates with IVF were similar for women with vs. without endometriosis, but women with more severe disease had significantly lower cumulative pregnancy rates vs. those with less severe disease, researchers reported.

“Although over 70% of women with endometriosis will become pregnant spontaneously, there are international guidelines on managing infertility in a setting of endometriosis. Depending on the endometriosis stage, one can consider either three to six intrauterine inseminations or an immediate switch to IVF,” Karine Morcel, MD, from the department of reproductive medicine at the Assisted Reproductive Technology Center, Brest University Medical Center, France, and colleagues wrote. “IVF is necessary in 10% to 25% of women with endometriosis, and the outcomes vary from one study to another.”

Morcel and colleagues conducted a retrospective study with data from 2,092 IVF cycles among 1,607 couples who participated in an IVF program from 2019 to October 2022. Researchers evaluated clinical and ongoing pregnancy rates with IVF and the cumulative pregnancy rates after frozen/thawed embryo transfers for women with and without endometriosis. In addition, researchers compared groups based on endometriosis severity.

Overall, women without endometriosis underwent 430 IVF cycles. Women with endometriosis underwent 460 IVF cycles: 56 for women with endometriosis stages I or II, 88 for those with endometriosis stages III or IV, and 316 for those with endometrioma alone.

Among women who had vitrified-thawed-transferred embryos, 46.5% had endometriosis and 47.7% did not. Of those with endometriosis, 61.1% had stages I or II, 33.3% had stages III or IV and 47.4% had endometrioma alone.

Ongoing pregnancy rates between women with and without endometriosis were not significantly different after fresh or frozen/thawed embryo transfers. Researchers noted that cumulative clinical pregnancy rates per couple were lower among women with endometriosis stages III or IV compared with the other groups (P < .01). In addition, cumulative ongoing pregnancy rates per couple were lower among women with endometriosis stages III or IV compared with stages 1 or 2 (P < .01) and women with endometrioma alone (P < .05).

“The value of initial surgical management of deep infiltrating endometriosis before IVF remains subject to debate. Other treatments for endometriosis might improve IVF outcomes,” the researchers wrote. “More prospective studies are needed to validate the IVF results and determine which women with endometriosis have the best IVF prognosis.”