Impact of endometriosis and its staging on assisted reproduction outcome: systematic review and meta-analysis

Barbosa, Marco Aurélio A.; Teixeira, D. M.; Navarro, Paula Andrea; Ferriani, Rui Alberto; Nastri, C.O.; Martins, Wellington P.

doi:10.1002/uog.13366

Cited by 104 publications

(83 citation statements)

References 178 publications

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“…Meanwhile, women with mild endometriosis showed comparable results in terms of implantation, clinical pregnancy and live birth rates [25]. In contrast, the review by Barbosa et al [26] did not report significant differences in live birth and clinical pregnancy rates among women with endometriosis as compared with other causes of infertility. Furthermore, reproductive outcomes were not affected by the severity of endometriosis.…”

Section: Discussionmentioning

confidence: 99%

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The impact of endometriosis on the outcome of Assisted Reproductive Technology

González-Comadran

Schwarze

Zegers‐Hochschild³

et al. 2017

Reprod Biol Endocrinol

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BackgroundEndometriosis has been described to impair fertility through various mechanisms. However, studies evaluating the reproductive outcomes of women undergoing assisted reproductive technologies show controversial results. The aim of this study is to assess whether the reproductive outcome is impaired among women with endometriosis-associated infertility undergoing IVF.MethodsA retrospective cohort study was performed, including women undergoing IVF reported by the Red Latinoamericana de Reproduccion Asistida (Redlara) registry, between January 2010 and December 2012. The study group included women with endometriosis-associated infertility, and the control group women with tubal factor, endocrine disorders or unexplained infertility. Women above 40 years, severe male factor and premature ovarian failure were excluded. The reproductive outcomes of between both groups were compared. The primary outcome was live birth. Secondary outcomes included clinical pregnancy, miscarriage, number of oocytes retrieved and number of fertilized oocytes. Outcomes were assessed after the first fresh IVF cycle, and were adjusted for age and number of embryos transferred.ResultsA total of 22.416 women were included (3.583 with endometriosis and 18.833 in the control group). Mean age of patients in the endometriosis group and control group was 34.86 (3.47) and 34.61 (3.91) respectively, p = 0.000. The mean number of oocytes retrieved were 8.89 (6.23) and 9.86 (7.02) respectively, p = 0.000. No significant differences were observed between groups in terms of live birth (odds ratio (OR) 1.032, p = 0.556), clinical pregnancy (OR 1.044, p = 0.428) and miscarriage rates (OR 1.049, p = 0.623). Women with endometriosis had significantly lower number of oocytes retrieved (incidence risk ratio (IRR) 0.917, 95% CI 0.895–0.940), however, the number of fertilized oocytes did not differ among the two groups when adjusting for the number of oocytes retrieved (IRR 1.003, p = 0.794). An age-stratified analysis was performed, and no differences were observed in the reproductive outcomes between groups for women aged under 35 and 35 to 40.ConclusionsReproductive outcomes among women undergoing IVF and diagnosed with endometriosis-associated infertility do not differ significantly from women without the disease. Although women with endometriosis generate fewer oocytes, fertilization rate is not impaired and the likelihood of achieving a live birth is also not affected.

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Section: Discussionmentioning

confidence: 99%

“…Most significantly, the large number of patients included in the study, the largest cohort published so far [26], which provided a considerable gain in statistical power. Besides, the prospective nature of the database in addition to its individualized case-by-case registry empower the results obtained in the analysis.…”

Section: Discussionmentioning

confidence: 99%

The impact of endometriosis on the outcome of Assisted Reproductive Technology

González-Comadran

Schwarze

Zegers‐Hochschild³

et al. 2017

Reprod Biol Endocrinol

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“…In the recent literature, we indeed identified seven studies reporting on the risk of abortion in women with endometriosis (10-16), of whom three showed a statistically significant positive association (11,14,16) (Table 1). Moreover, two recent meta-analyses investigating the rate of miscarriage in women with endometriosis achieving pregnancy through IVF reported an about 30% increased risk (17,18). On the other hand, it is crucial to emphasize that the study designs of these epidemiological studies are generally weak and the results inevitably exposed to significant biases.…”

Section: Discussionmentioning

confidence: 99%

“…For this reason, matching rather than adjusting for age is in our opinion more appropriate. Noteworthy, the above-mentioned meta-analyses on the risk of abortion in women with endometriosis undergoing IVF do not adjust for age since the authors aggregated crude data (17,18).…”

Section: Discussionmentioning

confidence: 99%

Risk of miscarriage in women with endometriosis: insights from in vitro fertilization cycles

Leonardi

Papaleo

Reschini

et al. 2016

Fertility and Sterility

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CapsuleWomen with endometriosis achieving singleton pregnancies with in vitro fertilization do not face an increased risk of miscarriage. Patients: Women achieving singleton pregnancies with the use of IVF were considered. Cases were women with a history of surgery for endometriosis and those who were documented the presence of ovarian endometriomas at the time of the IVF cycle (n=313). Controls were matched to cases by age (± 6 months), type of cycle (fresh or frozen cycle) and study period (n=313).Interventions: Retrospective review of women undergoing IVF. Main outcome measures: Rate of miscarriage before 12 weeks' gestationResults: The number of miscarriages in women with and without endometriosis was similar, being 48 (15%) and 60 (19%), respectively. The Odds Ratio (OR) of miscarriage in affected women was 0.76 (95%CI: 0.50-1.16). The OR adjusted for body mass index, parity, duration of infertility and male factor was 0.81 (95%CI: 0.53-1.25). Subgroup analyses according to the type of cycle, the number of embryos transferred, the presence of endometriomas and the history of surgery for endometriosis did not document any subgroup at significant increased risk of miscarriage. Conclusions:The risk of miscarriage is not increased in women with endometriosis achieving pregnancy with the use of IVF.

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“…Other recent meta-analyses on the outcomes of ART in patients with endometriosis unfortunately do not provide data on the quality of oocytes as indicated by number of MII oocytes retrieved or fertilized [66, 67]. For this reason, recent publications providing additional evidence were individually retrieved and are herein discussed.…”

Section: Endometriosis and Clinical Markers Of Oocyte Qualitymentioning

confidence: 99%

Is the oocyte quality affected by endometriosis? A review of the literature

et al. 2017

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Endometriosis is an estrogen-dependent chronic inflammatory condition that affects women in their reproductive period causing infertility and pelvic pain. The disease, especially at the ovarian site has been shown to have a detrimental impact on ovarian physiology. Indeed, sonographic and histologic data tend to support the idea that ovarian follicles of endometriosis patients are decreased in number and more atretic. Moreover, the local intrafollicular environment of patients affected is characterized by alterations of the granulosa cell compartment including reduced P450 aromatase expression and increased intracellular reactive oxygen species generation. However, no comprehensive evaluation of the literature addressing the effect of endometriosis on oocyte quality from both a clinical and a biological perspective has so far been conducted. Based on this systematic review of the literature, oocytes retrieved from women affected by endometriosis are more likely to fail in vitro maturation and to show altered morphology and lower cytoplasmic mitochondrial content compared to women with other causes of infertility. Results from meta-analyses addressing IVF outcomes in women affected would indicate that a reduction in the number of mature oocytes retrieved is associated with endometriosis while a reduction in fertilization rates is more likely to be associated with minimal/mild rather than with moderate/severe disease. However, evidence in this field is still far to be conclusive, especially with regards to the effects of different stages of the disease and to the impact of patients’ previous medical/surgical treatment(s).

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Impact of endometriosis and its staging on assisted reproduction outcome: systematic review and meta-analysis

Abstract: Objective To evaluate whether the presence or severity of endometriosis affects the outcome of assisted reproductive techniques (ART). Methods RR = 0.94 (95% CI, clinical pregnancy, RR = 0.90 (95% CI,

Cited by 104 publications

References 178 publications

The impact of endometriosis on the outcome of Assisted Reproductive Technology

The impact of endometriosis on the outcome of Assisted Reproductive Technology

Risk of miscarriage in women with endometriosis: insights from in vitro fertilization cycles

Is the oocyte quality affected by endometriosis? A review of the literature

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