Beyond oocyte quantity: the paradoxical role of poor ovarian response in live birth outcomes among endometriosis patients undergoing IVF/ICSI-ET

PURPOSE: To evaluate the impact of poor ovarian response (POR) on live birth outcomes in endometriosis patients undergoing IVF/ICSI-ET, despite the expected association between reduced oocyte yield and poorer prognosis. METHODS: Patients were divided into two groups as endometriosis group (n = 55) and tubal factor group (n = 107). The primary outcomes included clinical pregnancy rate, live birth rate per embryo transfer cycle, and cumulative live birth rate. Secondary outcomes were controlled ovarian hyperstimulation (COH) results and embryo parameters. RESULTS: The incidence rate of POR increased significantly in endometriosis group (18.9% vs. 5.60%, P < 0.05). Similarly, the number of oocytes retrieved, the number of D3 high quality embryos, and the number of available embryos were fewer in endometriosis group (P < 0.05). However, total number of available embryos, clinical pregnancy rates per transfer cycle, live birth rates per transfer cycle, and cumulative birth rate were found to be similar in both groups (P > 0.05). The presence of POR was found to have no significant impact on the cumulative live birth rate among patients with endometriosis. CONCLUSIONS: While linked to fewer oocytes per cycle, POR does not predict poorer IVF/ICSI-ET outcomes in endometriosis patients. Patient age, not POR or endometriosis itself, is the primary determinant of live birth success. This study challenges the conventional emphasis on oocyte quantity, advocating for a paradigm shift toward individualized, quality-focused ART strategies in endometriosis-related infertility.