Prognostic factors for assisted reproductive technology in women with endometriosis-related infertility

Chloé Maignien, Maignien C, Santulli P, Piétro Santulli, Pietro Santulli, Gayet V, Vanessa Gayet, Lafay-Pillet MC, Marie-Christine Lafay-Pillet, Diane Korb, Korb D, Mathilde Bourdon, Bourdon M, Louis Marcellin, Marcellin L, Dominique de Ziegler, de Ziegler D, Chapron C, Charles Chapron
American journal of obstetrics and gynecology · 2016 · vol. 216(3) , pp. 280.e1–280.e9 · doi:10.1016/j.ajog.2016.11.1042 · PMID:27899313 · W2556368651
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This study identified factors predicting successful assisted reproductive technology outcomes for women experiencing infertility due to endometriosis.

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Abstract

BackgroundAssisted reproductive technology is one of the therapeutic options offered for managing endometriosis-associated infertility. Yet, published data on assisted reproductive technology outcome in women affected by endometriosis are conflicting and the determinant factors for pregnancy chances unclear.ObjectiveWe sought to evaluate assisted reproductive technology outcomes in a series of 359 endometriosis patients, to identify prognostic factors and determine if there is an impact of the endometriosis phenotype.Study designThis was a retrospective observational cohort study, including 359 consecutive endometriosis patients undergoing in vitro fertilization or intracytoplasmic sperm injection, from June 2005 through February 2013 at a university hospital. Endometriotic lesions were classified into 3 phenotypes-superficial peritoneal endometriosis, endometrioma, or deep infiltrating endometriosis-based on imaging criteria (transvaginal ultrasound, magnetic resonance imaging); histological proof confirmed the diagnosis in women with a history of surgery for endometriosis. Main outcome measures were clinical pregnancy rates and live birth rates per cycle and per embryo transfer. Prognostic factors of assisted reproductive technology outcome were identified by comparing women who became pregnant and those who did not, using univariate and adjusted multiple logistic regression models.ResultsIn all, 359 endometriosis patients underwent 720 assisted reproductive technology cycles. In all, 158 (44%) patients became pregnant, and 114 (31.8%) had a live birth. The clinical pregnancy rate and the live birth rate per embryo transfer were 36.4% and 22.8%, respectively. The endometriosis phenotype (superficial endometriosis, endometrioma, or deep infiltrating endometriosis) had no impact on assisted reproductive technology outcomes. After multivariate analysis, history of surgery for endometriosis (odds ratio, 0.14; 95% confidence ratio, 0.06-0.38) or past surgery for endometrioma (odds ratio, 0.39; 95% confidence ratio, 0.18-0.84) were independent factors associated with lower pregnancy rates. Anti-müllerian hormone levels <2 ng/mL (odds ratio, 0.51; 95% confidence ratio, 0.28-0.91) and antral follicle count <10 (odds ratio, 0.27; 95% confidence ratio, 0.14-0.53) were also associated with negative assisted reproductive technology outcomes.ConclusionThe endometriosis phenotype seems to have no impact on assisted reproductive technology results. An altered ovarian reserve and a previous surgery for endometriosis and/or endometrioma are associated with decreased pregnancy rates.

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Condition tags

endometriosisinfertility

MeSH descriptors

Endometriosis Infertility, Female Peritoneal Diseases Reproductive Techniques, Assisted Adult Cohort Studies Endometriosis Endometriosis Female Humans Infertility, Female Live Birth Peritoneal Diseases Peritoneal Diseases Phenotype Pregnancy Pregnancy Rate Prognosis Retrospective Studies

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