{"paper_id":"7dcad103-ac9d-4f1e-b992-055371dbf244","body_text":"Abstract\nBackground\nOvarian endometrioma (OMA) is associated with reduced in vitro fertilization (IVF) success rates. Therefore, the purpose of the study is to investigate risk factors associated with pregnancy outcomes following IVF in women with OMA and assess the predictive utility of maximum OMA diameter.\nMethods\nThis propensity score-matched retrospective cohort study enrolled 2416 women who underwent IVF between December 2020 and November 2025. A total of 248 transvaginal ultrasound (TVUS)-confirmed OMA patients who underwent IVF were allocated to the OMA group. Conversely, 2,168 concurrently enrolled patients without ultrasonographically confirmed OMA who underwent IVF were assigned to the non-OMA group. A sample size of 738 was calculated to achieve a statistical power of 99.9% and a two-sided α of 0.05. Age, body mass index (BMI), and controlled ovarian hyperstimulation (COH) protocols were adjusted between the two groups using propensity score matching (PSM) at a 1:3 ratio. After PSM, 248 OMA patients were matched to 738 patients without OMA who underwent IVF. Additionally, 248 OMA patients were stratified into pregnant and non-pregnant groups according to clinical pregnancy outcome, and factors associated with clinical pregnancy among these patients were identified.\nResults\nAfter PSM, multivariate logistic regression revealed that type of infertility, number of abortions and cesarean deliveries, and level of sex hormones were independent factors for OMA, and OMA independently influenced clinical pregnancy and early abortion rates (P < 0.05). In the OMA group, multivariate logistic regression identified age, abortion number, COH protocols, and maximum OMA diameter as independent predictors of clinical pregnancy outcomes. The integrated predictive model exhibited an area under the receiver operating characteristic curve (AUC) of 0.857, with optimal predicted cutoff values of 32.5 years for age and 21.25 mm for maximum OMA diameter.\nConclusions\nThe retrospective analysis delineated infertility type, obstetric history, and sex hormone profiles as independent risk factors for ovarian cysts. OMA subgroup analysis demonstrated age, abortion count, COH protocols, and maximum OMA diameter as key predictors of IVF outcomes.\nRegistry\nThe Ethics Review Committee of the Jiangsu Provincial Hospital of Traditional Chinese Medicine, approval number:2021NL-045-03, Registration date: 16 January 2021.\nSimilar content being viewed by others\nAbbreviations\n- 2D-TVS:\n-\nTwo-dimensional transvaginal sonography\n- AFC:\n-\nAntral follicle count\n- AMH:\n-\nAnti-Müllerian hormone\n- ART:\n-\nAssisted reproductive technology\n- AUC:\n-\nArea under the receiver operating characteristic curve\n- BMI:\n-\nBody mass index\n- CI:\n-\nConfidence interval\n- COH:\n-\nControlled ovarian hyperstimulation\n- DCA:\n-\nDecision curve analysis\n- DIE:\n-\nDeep infiltrating endometriosis\n- E2:\n-\nEstradiol\n- ESHRE:\n-\nEuropean Society of Human Reproduction and Embryology\n- FET:\n-\nFrozen-thawed embryo transfer\n- FIGO:\n-\nInternational Federation of Gynecology and Obstetrics\n- FSH:\n-\nFollicle-stimulating hormone\n- Gn:\n-\nGonadotropin\n- GnRH:\n-\nGonadotropin-releasing hormone\n- IVF:\n-\nIn vitro fertilization\n- IVF-ET:\n-\nIn vitro fertilization-embryo transfer\n- IQR:\n-\nInterquartile range\n- LH:\n-\nLuteinizing hormone\n- OMA:\n-\nOvarian endometrioma\n- OR:\n-\nOdds ratio\n- PSM:\n-\nPropensity score matching\n- PRL:\n-\nProlactin\n- ROC:\n-\nReceiver operating characteristic\n- ROS:\n-\nReactive oxygen species\n- SD:\n-\nStandard deviation\n- TVUS:\n-\nTransvaginal ultrasound\n- WOI:\n-\nWindow of implantation\n- 2PN:\n-\n2-Pronuclear\nAcknowledgements\nNot applicable.\nFunding\nSupported by the National Key R&D Program of China (Award Number: 2024YFC3505800) and the Key Disease Research Project of Jiangsu Provincial Hospital of Chinese Medicine (Grant No. YZJ2406).\nAuthor information\nAuthors and Affiliations\nCorresponding authors\nEthics declarations\nEthics approval and consent to participate\nEthical approval for this study was granted by the Ethics Review Committee of the Jiangsu Provincial Hospital of Traditional Chinese Medicine (approval number: 2021NL-045-03). All participants provided written informed consent. The study was conducted in accordance with the principles of the Declaration of Helsinki.\nConsent for publication\nNot applicable.\nCompeting interests\nThe authors declare no competing interests.\nAdditional information\nPublisher’s note\nSpringer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.\nRights and permissions\nOpen Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.\nAbout this article\nCite this article\nWang, Y., Zhang, Y., Wang, X. et al. Predictors of clinical pregnancy after IVF in women with ovarian endometriomas: a propensity score-matched retrospective cohort study. BMC Pregnancy Childbirth (2026). https://doi.org/10.1186/s12884-026-10060-0\nReceived:\nAccepted:\nPublished:\nDOI: https://doi.org/10.1186/s12884-026-10060-0","source_license":"CC0","license_restricted":false}