P-345 Impacts of endometriosis and ovarian endometrioma surgery on IVF/ICSI outcomes: a propensity-score matching analysis

Abstract Study question The impact of endometriosis on cumulative live birth rate (CLBR) is still debated, and whether a history of endometrioma improves pregnancy outcomes is inconclusive. Summary answer Endometriosis patients showed fewer oocytes retrieved and lower CLBR. A history of ovarian endometrioma surgery decreased the early miscarriage rate, albeit lower CLBR was observed. What is known already Endometriosis is characterized by dysmenorrhoea, pelvic pain, and infertility, affecting 10% of reproductive-age women. Currently, the impact of endometriosis on CLBR is still debated. Studies showed that CLBR in patients with endometriosis was 10% lower than that in patients without endometriosis, which may be caused by lower number and quality of oocytes. In contrast, another study found that clinical pregnancy rate and live birth rate were comparable in patients with endometriosis undergoing single blastocyst transfers. Moreover, ovarian endometrioma is a common phenotype, affecting nearly 40% of patients with endometriosis. Whether endometrioma surgery before IVF improves pregnant outcomes is inconclusive. Study design, size, duration This retrospective cohort study included women with endometriosis at the reproductive medicine center from January, 2016 to December, 2021. Finally, 1247 patients in the endometriosis group and 3510 patients in the control group met the inclusion and exclusion criteria. Patients with endometrioma were divided into two groups: (A) underwent endometrioma surgery (n = 485); (B) diagnosis based on ultrasound without endometrioma surgery (293). Participants/materials, setting, methods Patients with endometriosis undergoing the first IVF/ICSI treatment cycle were included. The control group comprised patients undergoing IVF/ICSI treatments because of tubal factor or male factor infertility. To adjust imbalances in baseline characteristics, propensity-score matching (PSM) was performed. Age, BMI, parity, median FSH and fertilization type were considered confounding factors. Furthermore, CLBR between different groups was analyzed with Kaplan-Meier (KM) curves using R. Subgroup analysis was performed based on whether undergoing endometrioma or not. Main results and the role of chance After PSM, 1219 patients with endometriosis were matched to 1219 patients in control group. The number of oocytes retrieved (11 vs. 13, P < 0.001) and available embryos (4.5 vs. 5.1, P < 0.001), blastocyst formation rate (40.0% vs. 50.0%, P = 0.009), cumulative clinical pregnancy rates (CPRs) (66.4% vs. 72.8%, P = 0.01) and CLBR (53.5% vs. 65.3%, P < 0.001) were lower in endometriosis group. Kaplan-Meier curves showed CLBRs decreased in women with endometriosis compared with control group (P < 0.001). Subgroup analyses revealed the number of oocytes retrieved (9 vs. 13, P < 0.001), available embryos (3 vs. 4, P < 0.001), blastocyst formation rate (16.7% vs. 50.0%, P < 0.001), cumulative CPRs (60.4% vs. 72.8%, P < 0.001) and CLBRs (49.7% vs. 63.9%, P < 0.001) were lower in group A compared to matched control group. Interestingly, the early miscarriage rate (6.0% vs. 9.9%, P < 0.001) was lower in group A. The lower number of oocytes retrieved (12 vs. 13, P < 0.001) and CLBRs (55.3% vs. 66.9%, P = 0.003) were observed in group B compared to control group, but early miscarriage rate, available embryos, blastocyst formation rate, and cumulative CPRs were comparable. Limitations, reasons for caution Patients from the control group had no surgical exclusion of endometriosis. Wider implications of the findings The results showed that endometriosis has a negative impact on embryo laboratory and pregnancy outcomes of IVF/ICSI. A previous history of surgery for ovarian endometrioma may decrease the early miscarriage rate. Further studies with a larger sample are required to explore the effect of endometrioma surgery on IVF outcomes. Trial registration number No