Recurrent endometriosis and IVF: is it still an enigma?

J Popović, Milan Stefanović, S.P. Trajkovic Dinic, Vladimir Antić, Milan Trenkić
In: Clinical and Experimental Obstetrics & Gynecology · 2018 · vol. 45(3) , pp. 410–413 · doi:10.12891/ceog4173.2018 · W3034855850
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⚙ AI-generated summary by claude@2026-06, 2026-06-28 ⓘ

This study found that patients with recurrent endometriosis who underwent multiple surgeries had poorer IVF outcomes compared to those with fewer surgeries or tubal factor infertility.

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⚙ AI-generated deep summary by claude@2026-07, 2026-07-09 · read from full text ⓘ

This study evaluated IVF outcomes in infertile patients with recurrent endometriosis by comparing 50 women once operated for endometriosis with no signs at IVF, 29 women once operated but with active disease signs at IVF, and 47 women who had more than one endometriosis surgery, with a control group of 157 tubal factor infertility patients. Across the groups, cancelled cycles were higher in the endometriosis cohorts than in controls, and especially higher after two or more endometriosis surgeries; oocyte retrieval and embryo yield were also reduced in those with multiple surgeries. Implantation, clinical and multifetal pregnancy, and birth rate per embryo transfer were significantly lower in women with two or more endometriosis surgeries compared with the other groups. The paper discusses its findings as evidence for worsened IVF outcomes after repeat endometriosis surgery, with the stated caveat that avoidance of repetitive surgery is not applicable in cases of unbearable pain or suspicious ovarian mass findings. This paper is centrally about endometriosis—specifically recurrent endometriosis and how multiple endometriosis surgeries relate to IVF outcomes.

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Abstract

The recurrence of endometriosis varies between 6% and 67%. If the patient is infertile and has recurrent endometriosis, she could be managed by repeat surgery or assisted reproduction. Given the increasing number of patients with recurrent endometriosis applying for IVF procedure, the aim of this study was to compare IVF outcome in patients who underwent one or more surgeries for endometriosis for the purpose of offering proper counseling to the infertile patients. The authors compared IVF outcome measures between 50 patients once operated for endometriosis with no signs of the disease at the time of IVF procedure, 29 patients also once operated for endometriosis with signs of the disease at the time of IVF procedure, and 47 patience more than once operated for endometriosis. Each group was also compared with a control group of 157 patients with tubal factor infertility. Outcome measures included number of follicles, number of oocytes, mean number of ampoules of gonadotropins, cumulative pregnancy, and live birth rates The rate of cancelled cycles was higher in all three groups of patients with endometriosis compared to the control group, and in addition, significantly higher in patients who underwent two or more endometriosis surgeries. The same applied for the number of oocytes retrieved by puncture and the number of the obtained embryos. The rate of implantation, clinical and multifetal pregnancies, as well as the birth rate per embryo transfer was significantly lower in patients who underwent endometriosis surgery two or more times, compared to all other groups of patients. When it comes to recurrent endometriosis, repeat surgery worsens the IVF outcome and therefore should be avoided. Except in cases of patients experiencing unbearable pain and suspicious ovarian mass findings, a patient with recurrent endometriosis should be immediately included in the IVF procedure without repetitive surgery.
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Abstract

The recurrence of endometriosis varies between 6% and 67%. If the patient is infertile and has recurrent endometriosis, she could be managed by repeat surgery or assisted reproduction. Given the increasing number of patients with recurrent endometriosis applying for IVF procedure, the aim of this study was to compare IVF outcome in patients who underwent one or more surgeries for endometriosis for the purpose of offering proper counseling to the infertile patients. The authors compared IVF outcome measures between 50 patients once operated for endometriosis with no signs of the disease at the time of IVF procedure, 29 patients also once operated for endometriosis with signs of the disease at the time of IVF procedure, and 47 patience more than once operated for endometriosis. Each group was also compared with a control group of 157 patients with tubal factor infertility. Outcome measures included number of follicles, number of oocytes, mean number of ampoules of gonadotropins, cumulative pregnancy, and live birth rates The rate of cancelled cycles was higher in all three groups of patients with endometriosis compared to the control group, and in addition, significantly higher in patients who underwent two or more endometriosis surgeries. The same applied for the number of oocytes retrieved by puncture and the number of the obtained embryos. The rate of implantation, clinical and multifetal pregnancies, as well as the birth rate per embryo transfer was significantly lower in patients who underwent endometriosis surgery two or more times, compared to all other groups of patients. When it comes to recurrent endometriosis, repeat surgery worsens the IVF outcome and therefore should be avoided. Except in cases of patients experiencing unbearable pain and suspicious ovarian mass findings, a patient with recurrent endometriosis should be immediately included in the IVF procedure without repetitive surgery.

Keywords

- Recurrent endometriosis - In vitro fertilization - Tubal factor infertility

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