Early Embryo Development in Women with Endometriosis: A Retrospective Study

Mukhri Hamdan, Matthew Cotterill, Y C Lim, Anthony N. Price, Ying Cheong
In: Fertility & Reproduction · 2025 · vol. 07(02) , pp. 89–94 · doi:10.1142/s2661318225500082 · W4412020791
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Women with endometriosis produced fewer oocytes per follicle and had higher early embryo arrest rates, indicating compromised oocyte quality, but later embryo development and pregnancy rates were unaffected.

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Abstract

Background: Endometriosis (EN) is known to be detrimental to fertility in many ways. Evidence drawn from oocyte recipient cycles suggests compromised oocyte quality in endometriosis. This retrospective case-control study aimed to evaluate embryo quality in women with endometriosis compared to those with tubal factor (TF) or unexplained infertility. Methods: IVF cycles from two fertility centres were retrospectively analysed for oocyte yield, fertilisation, early embryo arrest and blastocyst formation. Multicentre retrospective studies were performed. Treatment cycles and embryology records of women with and without endometriosis undergoing IVF were reviewed via the IDEAS TM database. The number of oocytes collected per mature follicle, fertilisation rate, pregnancy rate, morphology and morphometric assessment of the embryo at all stages were evaluated. Results: Women with endometriosis had fewer oocytes per mature follicle and a higher proportion of embryos that failed to reach the 8-cell stage. However, fertilisation rate, blastocyst formation and clinical pregnancy rate were not significantly different. A total of 678 women who had IVF treatment were analysed (EN, [Formula: see text] = 89; TF, [Formula: see text] = 214; unexplained subfertility [UE], [Formula: see text] = 375). The mean age for each group were EN, 34.4± 3.3; TF, 33.5± 3.7 and UE, 34.6± 3.2, respectively. The number of mature follicles (>14 mm) on the day of trigger injection was similar ([Formula: see text] = 0.75) between all groups. The percentage of oocytes collected per mature follicle was lower in endometriosis compared to other groups ([Formula: see text] = 0.01; EN, 65± 23; TF, 76± 20; UE, 71± 24). Higher percentages of embryos fail to achieve the 8-cell stage in EN compared to control groups ([Formula: see text] = 0.02; EN, 4.0± 1.6 TF, 1.2± 0.4; UE, 1.5 ± 0.4). Percentages of embryos at all grades (Grade 1–4) per woman were similar between the comparison groups ([Formula: see text] > 0.05). EN did not impair ([Formula: see text] > 0.05) blastocyst development or the development of fully expanded hatching blastocysts (FEHB). Conclusions: EN may impair early embryo development through compromised oocyte quality, but not later embryo development or pregnancy rate. This study finds women with endometriosis have a lower number of oocytes per total number of follicles. The presence of endometriosis is associated with a higher rate of early embryo arrest, which implicates poor oocyte quality. However, endometriosis has no effect on the embryo quality beyond the 8-cell stage of embryo development.
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Abstract

Background: Endometriosis (EN) is known to be detrimental to fertility in many ways. Evidence drawn from oocyte recipient cycles suggests compromised oocyte quality in endometriosis. This retrospective case-control study aimed to evaluate embryo quality in women with endometriosis compared to those with tubal factor (TF) or unexplained infertility.

Methods

IVF cycles from two fertility centres were retrospectively analysed for oocyte yield, fertilisation, early embryo arrest and blastocyst formation. Multicentre retrospective studies were performed. Treatment cycles and embryology records of women with and without endometriosis undergoing IVF were reviewed via the IDEASTM database. The number of oocytes collected per mature follicle, fertilisation rate, pregnancy rate, morphology and morphometric assessment of the embryo at all stages were evaluated.

Results

Women with endometriosis had fewer oocytes per mature follicle and a higher proportion of embryos that failed to reach the 8-cell stage. However, fertilisation rate, blastocyst formation and clinical pregnancy rate were not significantly different. A total of 678 women who had IVF treatment were analysed (EN, = 89; TF, = 214; unexplained subfertility [UE], = 375). The mean age for each group were EN, 34.4± 3.3; TF, 33.5± 3.7 and UE, 34.6± 3.2, respectively. The number of mature follicles (>14 mm) on the day of trigger injection was similar ( = 0.75) between all groups. The percentage of oocytes collected per mature follicle was lower in endometriosis compared to other groups ( = 0.01; EN, 65± 23; TF, 76± 20; UE, 71± 24). Higher percentages of embryos fail to achieve the 8-cell stage in EN compared to control groups ( = 0.02; EN, 4.0± 1.6 TF, 1.2± 0.4; UE, 1.5 ± 0.4). Percentages of embryos at all grades (Grade 1–4) per woman were similar between the comparison groups ( > 0.05). EN did not impair ( > 0.05) blastocyst development or the development of fully expanded hatching blastocysts (FEHB).

Conclusions

EN may impair early embryo development through compromised oocyte quality, but not later embryo development or pregnancy rate. This study finds women with endometriosis have a lower number of oocytes per total number of follicles. The presence of endometriosis is associated with a higher rate of early embryo arrest, which implicates poor oocyte quality. However, endometriosis has no effect on the embryo quality beyond the 8-cell stage of embryo development.

References

- 1. . Impact of endometriosis on in vitro fertilization outcomes: an evaluation of the SART database. Fertil Steril. 2016; 106 :164–171.e1. Crossref, Google Scholar - 2. , Ovarian endometriomas and oocyte quality: insights from IVF cycles. Fertil Steril. 2014; 101 :988–993.e1. Crossref, Google Scholar - 3. . Effects of ovarian endometrioma on embryo quality. Fertil Steril. 2011; 95 :2700–2702. Crossref, Google Scholar - 4. . Influence of endometriosis on ART outcomes: a systematic review and meta-analysis. Obstet Gynecol. 2015; 125 :79–88. Crossref, Google Scholar - 5. . Effect of endometriosis on in vitro fertilization. Fertil Steril. 2002; 77 :1148–55. Crossref, Google Scholar - 6. . Impact of endometrioma on IVF/ICSI outcomes: a systematic review and meta-analysis. Hum Reprod Update. 2015; 21 :809–25. Crossref, Google Scholar - 7. , Endometriosis and IVF outcome: a systematic review and meta-analysis. BJOG. 2013; 120 :1308–15. Crossref, Google Scholar - 8. , IVF outcome in endometriosis-associated infertility: a 5-year cohort. Chin Med J. 2012; 125 :2688–93. Google Scholar - 9. . Follicular fluid from infertile women with mild endometriosis compromises bovine MII spindles. Hum Reprod. 2014; 29 :315–23. Crossref, Google Scholar - 10. . Endometriosis-induced alterations in mouse metaphase-II oocyte microtubules. Fertil Steril. 2010; 94 :1894–99. Crossref, Google Scholar - 11. . DNA-damage checkpoint sensitivity prevents oocyte maturation in endometriosis. Sci Rep. 2016; 6 :36994. Crossref, Google Scholar - 12. , Stage III–IV endometriosis in sibling-oocyte recipients. Fertil Steril. 2000; 74 :31–4. Crossref, Google Scholar - 13. , Outcome of endometriosis patients in assisted reproduction. Hum Reprod. 1994; 9 :725–29. Crossref, Google Scholar - 14. . Impact of endometriosis on IVF/ICSI outcomes. Int J Clin Exp Pathol. 2013; 6 :1911–18. Google Scholar - 15. . Stage-related effect of endometriosis on IVF outcome. J Obstet Gynaecol Can. 2006; 28 :888–91. Crossref, Google Scholar - 16. . Early endometriosis and IVF-ET outcomes. Front Biosci (Elite Ed). 2013; 5 :720–24. Crossref, Google Scholar - 17. , Ovarian endometrioma and IVF outcome. Fertil Steril. 2005; 83 :908–13. Crossref, Google Scholar - 18. , Oocyte quality is decreased in minimal/mild endometriosis. Sci Rep. 2015; 5 :10779. Crossref, Google Scholar - 19. , Predicting aneuploidy in human oocytes. Hum Reprod. 2010; 25 :2374–86. Crossref, Google Scholar - 20. . Peritoneal fluid and sperm DNA damage. Fertil Steril. 2009; 92 :61–7. Crossref, Google Scholar - 21. , Spindle imaging and ROS in endometriosis. J Hum Reprod Sci. 2012; 5 :187–93. Crossref, Google Scholar - 22. , Maternal age, embryo morphology and aneuploidy. Reprod Biomed Online. 2007; 14 :628–34. Google Scholar - 23. Alpha Scientists in Reproductive Medicine; ESHRE SIG Embryology . Istanbul consensus on embryo assessment. Hum Reprod. 2011; 26 :1270–83. Crossref, Google Scholar - 24. , Cellular and molecular features of the endometriotic ovarian cyst. Hum Reprod Update. 2014; 20 :217–30. Crossref, Google Scholar - 25. , Rhythmic actomyosin contractions predict embryo viability. Nat Commun. 2011; 2 :417. Crossref, Google Scholar - 26. , Blastulation rates and embryo ploidy. Fertil Steril. 2014; 102 :394–98. Crossref, Google Scholar - 27. , Stage-dependent impact of endometriosis on IVF-ET cycles. Acta Obstet Gynecol Scand. 2011; 90 :1232–38. Crossref, Google Scholar - 28. , ESHRE guideline: management of endometriosis. Hum Reprod. 2014; 29 :400–12. Crossref, Google Scholar - 29. , GnRH antagonist vs agonist long protocol in normal responders. PLOS One. 2017; 12 :e0175985. Google Scholar - 30. , GnRH antagonists for ART. Cochrane Database Syst Rev. 2016; 4 :CD001750. Google Scholar - 31. . GnRH antagonist vs agonist in normal responders: meta-analysis. PLoS One. 2014; 9 :e106854. Crossref, Google Scholar

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