Pregnancy outcomes in women with endometriosis-associated pelvic pain: an observational cohort study of natural and assisted conceptions

Objective Pelvic pain is a cardinal symptom of endometriosis, but whether it independently predicts reproductive outcomes, and whether this association differs between spontaneous conception and assisted reproductive technology (ART), remains unclear. This study aimed to evaluate the association of moderate-to-severe pelvic pain with live birth and obstetric complications in women with endometriosis, and to examine whether these associations differed by conception pathway.

In this observational cohort study, we analyzed data from 1,063 women with endometriosis who intended to conceive, stratified by conception pathway (ART vs. spontaneous). Moderate-to-severe pain was defined as a visual analog scale (VAS) score ≥ 4 in at least one pain domain. Pathway-specific multivariable logistic regression models were used to assess the independent association between pain severity and reproductive outcomes, with live birth as the primary outcome. Obstetric complications were analyzed as secondary exploratory outcomes using unadjusted comparisons.

Moderate-to-severe pain was not independently associated with live birth in either pathway after adjustment for clinically relevant confounders. In the ART pathway, exploratory analyses showed a higher observed incidence of placenta accreta spectrum disorders among women with moderate-to-severe pain than among those with no/mild pain (9.0% vs. 3.2%). However, this finding was based on a small number of events and unadjusted comparisons. No comparable pattern was observed in the spontaneous conception pathway.

In women with endometriosis, moderate-to-severe pelvic pain was not independently associated with live birth in either the ART or spontaneous conception pathway. Exploratory findings suggested a possible association between more severe pain and a higher incidence of placenta accreta spectrum disorders in the ART pathway, but this observation should be interpreted cautiously and regarded as hypothesis-generating. Similar content being viewed by others

This study was carried out with the kind collaboration of the participants. We would also like to appreciate of the staff of the First Affiliated Hospital of Anhui Medical University for their valuable contributions. Funding This study was supported by Research Funds of Center for Data and Population Health of IHM (JKS2022009) and the National Natural Science Foundation of China (No.82171619). Author information Authors and Affiliations Corresponding author Ethics declarations Ethics approval and consent to participate This study was approved by the Ethics Review Committee of the First Affiliated Hospital of Anhui Medical University (PJ2021-05-16). All the participants provided written informed consent. Consent for publication All authors have approved the manuscript and agree with its submission. Competing interests The authors declare no competing interests. Additional information Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Supplementary information Below is the link to the electronic supplementary material. Rights and permissions Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/. About this article Cite this article Xu, Y., Deng, X., Li, W. et al. Pregnancy outcomes in women with endometriosis-associated pelvic pain: an observational cohort study of natural and assisted conceptions. BMC Pregnancy Childbirth (2026). https://doi.org/10.1186/s12884-026-10135-y Received: Accepted: Published: DOI: https://doi.org/10.1186/s12884-026-10135-y