Women with endometriosis who undergo IVF: a contemporary review of therapeutic strategies for successful outcomes

Alexander Kotlyar, Alexander M Kotlyar, David B Seifer
Reproductive biology and endocrinology : RB&E · 2025 · vol. 24(1) , pp. 1 · doi:10.1186/s12958-025-01506-9 · PMID:41345661 · W4416984876
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⚙ AI-generated summary by claude@2026-06, 2026-06-08 ⓘ

This review summarizes current strategies for optimizing IVF outcomes in women with endometriosis, covering disease burden reduction, ovulation induction, and implantation maximization.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-09 ⓘ

This contemporary narrative review examined IVF therapeutic strategies for women with surgically confirmed endometriosis and infertility, synthesizing evidence on pretreatment and timing, medical and surgical reduction of disease burden, ovarian stimulation approaches, and frozen-thawed embryo transfer to maximize oocyte/embryo yield and implantation. Across included studies (selected from 1946–2025 searches), the review reports that preparation strategies such as short-term oral contraceptive pretreatment can improve oocyte and frozen embryo yields, and dienogest pretreatment has shown higher implantation, clinical pregnancy, and live birth rates in some studies, with an RCT comparing dienogest to GnRH agonists finding similar outcomes but lower cost. A major caveat emphasized is that not all pretreatment data are consistent, with a meta-analysis showing no clear dienogest benefit and substantial heterogeneity and potential selection bias across studies. This paper is centrally about endometriosis — it focuses on optimizing IVF outcomes for infertile women with endometriosis, including especially issues related to advanced disease and endometriomas.

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Abstract

Endometriosis remains one of the most challenging chronic conditions to treat in gynecology. This condition is further complicated when patients concomitantly present with a history of infertility even though many will eventually progress to treatment with in-vitro fertilization (IVF). However, endometriosis presents its own unique set of challenges when preparing a patient for and performing an IVF cycle. This is especially the case when endometriomas are present and contribute to the diagnosis of advanced stage endometriosis (revised ASRM classification system, stages III-IV). In this review, we provide a summary of contemporary strategies to optimize IVF outcomes for patients with this systemic disease. Such strategies range from efforts and timing of such efforts to reduce disease burden via medical and surgical approaches, methods to optimize ovulation induction for maximizing egg/embryo yield as well as strategies to maximize success of implantation during embryo transfer. In addition, we delve into future strategies to reduce endometriosis disease burden which have the potential to improve IVF outcomes. This review provides a contemporary approach to optimizing IVF outcomes in patients with endometriosis of various stages.

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Outcome instruments

rASRM

Condition tags

endometriosisinfertility

Citation neighborhood

Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. [ expand to 2 hops ] — adds papers reached through this work's immediate citers/citees. Heavier; up to 60 extra dots.

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