Couples with mild male factor infertility and at least 3 failed previous IVF attempts may benefit from laparoscopic investigation regarding assisted reproduction outcome

Agni Pantou, Konstantinos Sfakianoudis, Evangelos Maziotis, Polina Giannelou, Sokratis Grigoriadis, Petroula Tsioulou, Georgia Kokkali, Michael Koutsilieris, Konstantinos Pantos, Mara Simopoulou
Scientific reports · 2020 · vol. 10(1) , pp. 2350 · doi:10.1038/s41598-020-59170-5 · PMID:32047198 · PMC7012822 · W3005765425
article OA: gold CC0 ⤵ 3 in-corpus citations
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⚙ AI-generated summary by claude@2026-06, 2026-06-07 ⓘ

Laparoscopic investigation and treatment of undiagnosed endometriosis in couples with mild male factor infertility and prior IVF failures improved pregnancy and live birth rates compared to no laparoscopy.

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

This prospective cohort study evaluated whether laparoscopic investigation and potential correction of previously undiagnosed endometriosis or pelvic adhesions could improve assisted reproduction outcomes for 169 couples with mild male factor infertility and at least three failed IVF attempts, compared with proceeding directly to a single ICSI cycle. Of 101 women who underwent laparoscopy, 43 were diagnosed with endometriosis and 22 with pelvic adhesions, while 36 had no further diagnosis; the authors report no statistically significant baseline differences in hormonal levels or characteristics between groups. Compared with the no-laparoscopy group, women who had laparoscopy had higher clinical pregnancy and ongoing pregnancy/live birth rates, and within the endometriosis subgroup after correction there was a trend toward fewer poor-quality blastocyst cycles (p = 0.056) and statistically significant higher clinical pregnancy and ongoing pregnancy/live birth rates versus male factor infertility only. The paper’s explicit caveat is that it is an option-based cohort (101 vs 68 opted into laparoscopy), which introduces selection differences (e.g., years of infertility differed), and outcomes were assessed after a single postoperative ICSI cycle. This paper is centrally about endometriosis in the context of IVF—laparoscopy for previously undiagnosed endometriosis in couples initially attributed to mild male factor infertility.

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Abstract

The aim of this study is to assess the value of laparoscopy for couples diagnosed with mild male factor infertility and at least three previous failed In-Vitro Fertilization (IVF) attempts. A total of 169 couples were included in this prospective cohort study. Patients were presented with the option of being subjected to laparoscopic investigation for correction of previously unidentified endometriosis or pelvic adhesions. The outcome measures were Live Birth/Ongoing Pregnancy, clinical pregnancy and positive hCG rate. One-hundred and one of them opted for, whereas 68 opted against laparoscopic investigation. All patients proceeded with a single ICSI cycle. Following laparoscopic investigation, 43 patients were diagnosed with endometriosis, 22 with adhesions, while for 36 patients laparoscopic investigation provided no further diagnosis. No statistically significant differences were observed regarding baseline hormonal levels and other characteristics between the two groups and the three subgroups. When compared to the no-laparoscopy group, women subjected to laparoscopy presented with a higher clinical pregnancy and ongoing pregnancy/live birth rate. Following endometriosis correction, a marginally non-statistically significant trend was observed regarding a decrease in poor-quality blastocysts (p = 0.056). A statistically significant higher clinical pregnancy (p = 0.03) and ongoing pregnancy/live birth rate was observed in the endometriosis group when compared to male factor infertility only (p = 0.04). Laparoscopic identification and correction of undiagnosed endometriosis in couples initially diagnosed with male infertility and at least 3 failed previous IVF attempts, appears to be a promising approach efficiently addressing infertility for these patients while avoiding IVF overuse.

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Condition tags

endometriosisinfertility

MeSH descriptors

Birth Rate Fertilization in Vitro Infertility, Male Laparoscopy Adult Female Fertilization in Vitro Humans Infertility, Male Infertility, Male Laparoscopy Male Outcome Assessment, Health Care Pregnancy Prospective Studies

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