Second child after a live birth achieved with assisted reproductive technology: a comparative analysis between endometriosis and other causes of infertility

RESEARCH QUESTION: What is the rate of second children among women affected from endometriosis who conceived their first child through Assisted Reproduction Technologies (ARTs)? Are there differences between endometriosis and other causes of infertility? DESIGN: The present retrospective monocentric cohort study was designed to evaluate the rate of second births among women who had their first child with the use of ARTs in our Center from 2013 to 2019. Women with endometriosis (exposed) were compared with a group of age-matched women with other causes of infertility (unexposed). The primary outcome was the desire for a second child. RESULTS: A total of n = 326 patients were included, n = 163 patients with endometriosis and n = 163 without the disease. Overall, n = 125 (77 %) and n = 136 (83 %) were interested in a second child (p = 0.17). The reasons for disregarding the possibility of having a second child in the two groups did not differ. The outcome among those interested in a second birth did not also differ. Natural conception occurred in n = 27 (22 %) and n = 29 (21 %) women (p = 0.96). Among those who did not conceive naturally (n = 98 and n = 107 subjects), n = 70 (71 %) and n = 88 (82 %) embarked in ART (p = 0.07). Live births were obtained in n = 39 (56 %) and n = 47 (53 %) women (p = 0.77). Survival curves on the chance of live birth (either naturally or ART-mediated) did not also differ (log-rank test, p = 0.11). CONCLUSIONS: Infertile women with endometriosis have the same desire and chance to have a second child as other infertile patients. Potential barriers associated to the disease such as the need for hormonal and inevitably contraceptive treatments, the lower ovarian reserve and reduced response to stimulation, and the fear about obstetrical complications are therefore unremarkable.