Objective To assess the impact of endometriosis alone, or in combination with other infertility diagnoses, on IVF outcomes Design Population-based retrospective cohort study of cycles from the Society for Assisted Reproductive Technology Clinic Outcome Reporting System database. Setting Not applicable. Patients 347,185 autologous fresh and frozen ART cycles from 2008-2010. Interventions None. Main Outcome Measure(s) oocyte yield, implantation rate, live birth rate (LBR) Results While cycles of patients with endometriosis comprised 11% of the study sample, the majority (64%) reported a concomitant diagnosis with male factor (42%), tubal factor (29%) and diminished ovarian reserve (22%) being the most common. Endometriosis, when isolated or with concomitant diagnoses, was associated with lower oocyte yield compared to those with unexplained infertility, tubal factor, and all other infertility diagnoses combined. Women with isolated endometriosis had similar or higher live birth rates compared to those in other diagnostic groups. However, women with endometriosis with concomitant diagnoses had lower implantation rates, and live birth rates compared to unexplained infertility, tubal factor, and all other diagnostic groups. Conclusions Endometriosis is associated with lower oocyte yield, lower implantation rates, and lower pregnancy rates after IVF. However the association of endometriosis and IVF outcomes is confounded by other infertility diagnoses. Endometriosis, when associated with other alterations in the reproductive tract has the lowest chance of live birth. In contrast, for the minority of women who have endometriosis in isolation, the live birth rate is similar or slightly higher compared to other infertility diagnoses.

Most IVF-conceived children are healthy, but IVF has also been associated with adverse obstetric and perinatal outcomes as well as congenital anomalies. There is also literature suggesting an association between IVF and neurodevelopmental disorders as well as potentially long-term metabolic outcomes. The main driver for adverse outcomes is the higher risk of multiple gestations in IVF, but as the field moves toward single embryo transfer, the rate of multiple gestations is decreasing. Studies have shown that singleton IVF pregnancies still have a higher incidence of adverse outcomes compared to unassisted singleton pregnancies. Infertility itself may be an independent risk factor. Animal models suggest that epigenetic changes in genes involved in growth and development are altered in IVF during the hormonal stimulation and embryo culture. Further animal research and prospective human data is needed to elucidate the mechanisms by which IVF may contribute to adverse outcomes and to decrease risks.

Dual trigger for final oocyte maturation using GnRHa and low-dose hCG is associated with a significantly increased risk of severe OHSS compared to GnRH alone. However, dual trigger may be associated with a modest increase in oocyte yield, both in terms of number and maturity.

Endometriosis is associated with infertility; however the etiology of this association is unclear, thus complicating management. Several mechanisms of pathogenesis have been proposed, however no one theory has been implicated. Medical therapy can be helpful in managing symptoms, but does not improve pregnancy rates. The role of surgical treatment remains controversial. There is little data regarding ovulation induction treatments for endometriosis only, while superovulation with intrauterine insemination has shown modest improvement in pregnancy rates in women who may have endometriosis. The most effective treatment for endometriosis-associated infertility is in-vitro fertilization. Recent focus on proteomics and genetics of the disease may aid in optimizing treatment options.

OBJECTIVE To assess reproductive choices of US reproductive age women and factors that influence consideration of elective egg freezing (EF). DESIGN Cross-sectional Internet based survey of 1000 women METHODS An anonymous 63-item self-administered questionnaire was distributed to a representative cross section of reproductive age women age 21–45, stratified by age