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

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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endometriosisinfertility

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