The impact of the localisation of endometriosis lesions on ovarian reserve and assisted reproduction techniques outcomes

Mahnaz Ashrafi, Arezoo Arabipoor, Mandana Hemat, Reza Salman Yazdi, Reza Salman-Yazdi
Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology · 2018 · vol. 39(1) , pp. 91–97 · doi:10.1080/01443615.2018.1465898 · PMID:30257599 · W2892551458
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Deep infiltrating endometriosis, with or without ovarian endometrioma, significantly decreases ovarian reserve and IVF/ICSI outcomes, impacting clinical pregnancy and live birth rates.

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Abstract

This case-control study was designed to evaluate the impact of endometriosis and the presence of endometrioma (OMA) per se on the serum anti-Müllerian hormone (AMH) level and also to compare the in vitro fertilisation/intracytoplasmic sperm injection (IVF/ICSI) outcomes after therapeutic surgery in endometriosis patients, according to the localisation of endometriosis lesions. One hundred and fifty two infertile women ≤40 years with suspicious symptoms were surgically evaluated to detect the aetiology of infertility at the Royan Institute during this study and, in parallel, 131 patients with a male factor infertility diagnosis were considered as the control group. The serum AMH level and IVF/ICSI outcomes were compared according to the nature and extension degree of endometriosis lesions. The results demonstrated that the existence of a deep infiltrating endometriosis (DIE) with and without OMA was associated with a significant decrease in AMH level, antral follicle count and ovarian sensitivity index (OSI) (p < .001 and p = .007, respectively). The multivariable logistic regression analysis adjusted for confounding factors indicated that the OSI and the existence of DIE with and without OMA were a significant predictive variable for clinical pregnancy and for live birth. On the basis of our results, the severity of endometriosis and the location of its lesions could affect an ovarian reserve and the ovarian stimulation outcomes. Impact Statement What is already known on this subject? Previous studies have evaluated the impact of endometrioma (OMA) on ovarian reserve and the assisted reproduction technology (ART) outcomes and controversial results have been reported; therefore, it seems that this topic still needs further research. What the results of this study add? In the present study, the effect of endometriosis lesions' localisation on ovarian reserve and the success rate of the in vitro fertilisation/intracytoplasmic sperm injection (IVF/ICSI) cycle after therapeutic surgery were compared with that of the control group. It was found that the existence of a deep infiltrating endometriosis (DIE) with and without OMA was associated with a significant decrease in the anti-Müllerian hormone (AMH) level, antral follicle count, ovarian sensitivity index (OSI), clinical pregnancy and live birth rates. What the implications are of these findings for clinical practice and/or further research? The results of this study has a practical value in the decision making process for the ovarian stimulation protocol in patients with the different severity of endometriosis and the counselling regarding the success rate of IVF or ICSI/embryo transfer cycles.

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Condition tags

mesh:D004715endometriosisdie_deep_infiltratingendometriomainfertility

MeSH descriptors

Infertility, Female Ovarian Reserve Severity of Illness Index Adult Anti-Mullerian Hormone Anti-Mullerian Hormone Birth Rate Case-Control Studies Endometriosis Endometriosis Endometriosis Female Fertilization in Vitro Fertilization in Vitro Humans Infertility, Female Logistic Models Ovulation Induction Ovulation Induction

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