Assisted Reproductive Technology in Women with Endometriosis and a History of Catamenial Pneumothorax: Reproductive Outcomes and Safety Considerations

STUDY OBJECTIVE: To describe reproductive outcomes and clinical safety considerations associated with assisted reproductive technology (ART) in women with a history of surgically treated catamenial pneumothorax (CP) (thoracic endometriosis syndrome). DESIGN: Retrospective case series conducted from January 2014 to December 2023. SETTING: Single tertiary academic center integrating reproductive medicine and thoracic surgery. PARTICIPANTS: Women aged 18 to 43 years with surgically treated CP were included. INTERVENTIONS: Exposure was ART in women with CP ultimately managed surgically, performed either before and/or after the thoracic operation; the timing of ART relative to surgery was recorded. MEASUREMENTS AND MAIN RESULTS: Primary outcomes were reproductive outcomes (including live birth rate per patient and per transfer) and safety outcomes (pneumothorax occurrence/recurrence and ART-related complications). Ten of the 11 patients (91%) had right-sided CP. Five women (45%) had undergone pelvic endometriosis surgery before thoracic management. Nineteen ovarian stimulation cycles were performed. Among infertile patients, seven of 10 (70%) achieved at least one live birth: five after in vitro fertilization with autologous oocytes, one after oocyte donation, and one after intrauterine insemination with donor sperm. Four women (36%) experienced their first pneumothorax episode within 4 months of ART. No thoracic recurrences were observed after surgery, despite subsequent ovarian stimulations. CONCLUSION: ART was associated with positive reproductive outcomes and a low rate of reported adverse events in women with a history of surgically treated CP, with no observed thoracic recurrences following treatment. Prospective studies are needed to further characterize outcomes and risks.