IVF live birth rate lower with deep infiltrating endometriosis, endometrioma

Key takeaways:

• Women with vs. without endometriosis and/or endometrioma had lower cumulative live birth rates.
• No differences were seen in number of retrieved mature oocytes, fertilization rates or good quality embryos.

Live birth rates were lower for women with vs. without deep infiltrating endometriosis and/or endometrioma undergoing first IVF/intracytoplasmic sperm injection, according to study results published in Fertility and Sterility.

“Assisted reproductive treatment (ART) is believed to be an efficient method to treat endometriosis-related subfertility. However, data regarding a potential impact of endometriosis on ART outcome is conflicting,” Sara Alson, MD, a research student in the department of clinical sciences at Obstetric, Gynecological and Prenatal Ultrasound Research at Lund University and the department of obstetrics and gynecology at the Reproductive Medicine Center at Skåne University Hospital, Sweden, and colleagues wrote. “Some studies suggest similar results after IVF or intracytoplasmic sperm injection (ICSI) treatment for women with and without endometriosis, whereas other report lower pregnancy rates and live birth rates in women with the disease.”

Alson and colleagues conducted a prospective observational cohort study with data from 1,040 subfertile women (mean age, 32 years) aged 25 to 39 years who underwent first IVF/ICSI treatment from 2019 to October 2022. In the cohort, 22.5% of women were diagnosed with deep infiltrating endometriosis and/or endometrioma via transvaginal ultrasonography. Diagnoses were made prior to first IVF/ICSI treatment.

Researchers evaluated the cumulative live birth rate after first IVF/ICSI cycle for women with and without deep infiltrating endometriosis and/or endometrioma.

Overall, 11.4% of women had deep infiltrating endometriosis without endometrioma and 4.7% had endometrioma without deep infiltrating endometriosis.

After first IVF/ICSI cycle, the cumulative live birth rate for all women in the cohort was 41%. Women with deep infiltrating endometriosis and/or endometrioma had a lower cumulative live birth rate compared with women without (33.3% vs. 43.2%; P = .007).

Women with deep infiltrating endometriosis and/or endometrioma had a crude RR of 0.77 (95% CI, 0.63-0.94) for cumulative live birth. After adjustments, researchers observed an adjusted RR for cumulative live birth of 0.63 (95% CI, 0.48-0.82) for women with deep infiltrating endometriosis and/or endometrioma. Women with endometrioma without deep infiltrating endometriosis had a lower cumulative live birth rate compared with women without deep infiltrating endometriosis and/or endometrioma (24.5% vs. 43.2%; P = .01). Women with deep infiltrating endometriosis without endometrioma had similar cumulative live birth rates as women without deep infiltrating endometriosis and/or endometrioma (37% and 43.2%, respectively).

In addition, researchers observed no differences in the number of retrieved mature oocytes, fertilization rates or good quality embryos between women with and without deep infiltrating endometriosis and/or endometrioma.

“Whether women with deep infiltrating endometriosis and/or endometrioma could achieve the same cumulative live birth rate as women without endometriosis after repeated cycles of IVF/ICSI treatment should be examined in future studies,” the researchers wrote. “Future studies will also reveal whether a concurrent presence of adenomyosis diagnosed with transvaginal ultrasonography affects the IVF/ICSI outcome.”