What is the impact of endometriosis and the AFS stage on cumulative pregnancy rates in IVF programs?

Karine Morcel, Philippe Merviel, Sarah Bouée, Mathilde Le Guillou, Marine Carlier, Pandora James, Hortense Drapier, Damien Beauvillard
Reproductive health · 2024 · vol. 21(1) , pp. 13 · doi:10.1186/s12978-024-01747-8 · PMID:38287446 · PMC10823753 · W4391317520
article OA: gold CC0 ⤵ 6 in-corpus citations
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⚙ AI-generated summary by claude@2026-06, 2026-06-07 ⓘ

This study found no significant difference in ongoing pregnancy rates between women with and without endometriosis undergoing IVF, but cumulative rates were lower for those with stage 3/4 endometriosis without endometrioma.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-07 ⓘ

Morcel et al. retrospectively studied IVF cycles from 2019–2022 in women aged 18–42, comparing women without endometriosis (matched to women with endometriosis by age, BMI, smoking, and infertility type) to women with endometriosis overall, and further by revised AFS stage into stage 1/2, stage 3/4 without endometrioma, and endometrioma alone; endometriosis diagnosis and staging were based on clinical assessment confirmed by MRI and/or laparoscopy. Across fresh or frozen/thawed embryo transfers, ongoing pregnancy rates did not significantly differ between endometriosis and non-endometriosis groups, but cumulative pregnancy rates per couple were significantly lower for AFS stage 3/4 without endometrioma. The authors report that pregnancy outcomes were similar to those seen with other infertility etiologies overall, while raising uncertainty about whether surgical resection of deep infiltrating endometriosis before IVF should be recommended. This paper is centrally about endometriosis — specifically, how AFS stage and endometrioma status impact cumulative pregnancy rates in IVF programs.

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Abstract

BACKGROUND: Endometriosis is commonly observed in infertile women and can be staged with regard to severity [e.g. according to the American Fertility Society (AFS) classification]. This condition can cause infertility through impaired oocyte quality, fertilization disorders, tubal lesions, adhesions, deep infiltration, and adenomyosis. Although women with endometriosis often turn to in vitro fertilization (IVF) programs, the literature data on IVF outcomes are sometimes contradictory (i.e. the same as in other etiologies of infertility, or worse). The objective of the present study was to assess and compare pregnancy rates in women with and without endometriosis and according to the endometriosis stage. METHODS: We retrospectively studied clinical and ongoing pregnancy rates in IVF and the cumulative pregnancy rates after frozen/thawed embryo transfers, in women without endometriosis (group A) or with endometriosis (group B). We further compared groups in which endometriosis was staged according to the revised AFS classification: stage 1/2 (group C), stage 3/4 (group D, without endometrioma), and endometrioma alone (group E). RESULTS: We documented 430 cycles in group A and 460 in group B (including 56 in group C, 88 in group D and 316 in group E). After fresh or frozen/thawed embryo transfers, the differences in ongoing pregnancy rates between groups A and B were not significant. However the cumulative rates per couple were significantly lower (p < 0.05) in group D. CONCLUSIONS: We recommend IVF for women with endometriosis because the pregnancy rates are similar to those observed for women with other types of infertility. This approach is in line with the international guidelines issued by assisted reproductive technology societies. These results again raise the question of whether surgical resection of deep infiltrating endometriosis (stage 3/4) should be recommended before admission to an IVF program. Trial registration This study was approved by an institutional review board (CPP Ouest VI, Brest, France): reference: B2020CE.43.

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Condition tags

endometriosisadenomyosisdie_deep_infiltratingendometriomainfertility

MeSH descriptors

Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis

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Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. [ expand to 2 hops ] — adds papers reached through this work's immediate citers/citees. Heavier; up to 60 extra dots.

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