Fertilité des femmes atteintes d’endométriose ayant bénéficié d’une congélation ovocytaire pour préservation de la fertilité

Objective Endometriosis is a chronic multifactorial pathology, characterized by the presence of ectopic endometrial tissue and present in 25-40% of infertile patients, thus a high number of women with endometriosis will resort to MAP (medically assisted procreation). In France since the 2014 bioethics law women with endometriosis can benefit from Fertility Preservation (FP) techniques. However, there is currently little data to date available in this population, particularly regarding changes in ovarian reserve and oocyte quality specific to endometriosis. The objective of this study was to evaluate the fertility (spontaneous or in AMP) of women who have undergone FP inthe context of endometriosis.Methods This was an observational, retrospective, bicentric study within the reproductive medicine departments of the Antoine Beclere and Jean Verdier Hospital Centers between 2013 and 2019. Women with imaging-confirmed endometriosis who had performed one or more cycles of ovarian stimulation with a view to gamete freezing for FP were included. Data were collected retrospectively from consulting medical records and endometriosis follow-up reports using MEDIFIRST software. After having undergone a fertility preservation technique, patients were regularly seen in thedepartment for fertility follow-up.Results and conclusion Our population consisted of 220 affected patients. The number of frozen gametes per patient was 14.7 ± 7.6. Women with endometriosis who tried to become pregnant at least 2 years after FP (41.3%) were more likely to have a partner at first visit (70.7% vs. 25.7%, p<0.0001); they were more likely to have had a child before FP (35.5% vs. 1.8%, p<0.0001) than those who did not try to get pregnant.Half of the pregnancies were obtained naturally, 12.5% following a new IVF attempt and 37.5% using frozen-gametes. Overall all, 47.9% of pregnancies resulted in live births in 31 women. Within the cohort, the chances of pregnancy at 4 years after the first FP consultation were estimated at 52% 95% CI [41% - 65%]. The estimated utilization rate of frozen oocytes and embryos two years after gamete freezing in the context of endometriosis is 7% 95% CI [4% - 12%] and 18% 95% CI [13% - 26%] 5years after freezing. Among the factors studied in women with a desire for pregnancy, only nulliparity was associated with a significant increase in the probability of oocyte utilization RR = 1.43 [1.0 - 2.06].