Assisted reproductive technology pregnancy complications are significantly associated with endometriosis severity before conception: a retrospective cohort study

Tatsuya Fujii, T. Fujii, Osamu Wada‐Hiraike, Osamu Wada-Hiraike, Takeshi Nagamatsu, Miyuki Harada, Tetsuya Hirata, Kaori Koga, Tomoyuki Fujii, Yutaka Osuga
Reproductive biology and endocrinology : RB&E · 2016 · vol. 14(1) , pp. 73 · doi:10.1186/s12958-016-0209-2 · PMID:27809920 · PMC5094074 · W2548132309
article OA: gold CC0 ⤵ 42 in-corpus citations
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⚙ AI-generated summary by claude@2026-06, 2026-06-08 ⓘ

Assisted reproductive technology pregnancies in women with endometriosis, particularly stage IV, showed significantly increased rates of preterm birth and placenta previa compared to those without endometriosis.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-08 ⓘ

This retrospective cohort study evaluated whether endometriosis severity predicts adverse pregnancy outcomes in singleton pregnancies conceived via assisted reproductive technology at a single facility between 2000 and 2014 (n=631), including 92 women with laparoscopically confirmed endometriosis staged by rASRM (I–II, III, IV) and 512 without endometriosis; preterm birth, placenta previa, and small for gestational age were defined using gestational and placental criteria. Adjusted logistic regression controlling for age, parity, and number of transferred embryos found that women with endometriosis had significantly higher odds of preterm birth (OR 2.08) and placenta previa (OR 15.1), with no significant association for SGA. When stratified by severity, rASRM stage IV endometriosis showed significantly increased odds of both preterm birth and placenta previa compared with rASRM stage I–III and with women without endometriosis, whereas stages I–III did not differ from no endometriosis. The main limitation is that endometriosis diagnosis relied on surgical findings and excluded certain patients, and rASRM stage was unavailable for a subset of cases. This paper is centrally about endometriosis — it links rASRM severity of endometriosis present before ART conception to increased risks of preterm birth and placenta previa.

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Abstract

BACKGROUND: Endometriosis has been shown to be associated with second- to third-trimester pregnancy complications such as preterm birth and placenta previa, but the evidence is inconsistent. We hypothesized that endometriosis severity might affect these inconsistent results. Therefore we aimed to conduct a retrospective cohort study to elucidate whether endometriosis severity is associated with the incidence rates of adverse pregnancy outcomes. METHODS: The patients who achieved singleton pregnancy by assisted reproductive technology (ART) in our facility between March 2000 and December 2014 (N = 631) were included in this analysis. Among them, 92 women demonstrated surgically proven endometriosis, and 512 women were shown to not have endometriosis as a complication. Among the 92 cases of endometriosis, 10 were classified as revised American Society for Reproductive Medicine (rASRM) stage I and II, 31 cases were rASRM stage III, and 43 cases were rASRM stage IV; in 8 cases, the rASRM stage was unavailable. Logistic regression analysis was performed to calculate odds ratios (OR) and 95 % confidence interval (CI) for the rates of preterm birth, placenta previa, and small for gestational age. OR were adjusted by age, parity and the number of transferred embryos. RESULTS: First we confirmed the frequency of preterm birth and placenta previa were significantly increased in women with endometriosis (preterm birth OR, 2.08; 95 % CI, 1.07-3.89, placenta previa OR, 15.1; 95 % CI, 4.40-61.7), while the frequency of small for gestational age was not. Moreover, we found the frequencies of preterm birth and placenta previa were significantly increased in women with rASRM stage IV endometriosis compared to other two groups: women with rASRM stage I-III endometriosis (preterm birth OR, 7.40; 95 % CI, 1.83-50.3; placenta previa OR, 11.0; 95 % CI, 1.75-216.5) and women without endometriosis (preterm birth adjusted OR, 4.11; 95 % CI, 1.88-8.55; placenta previa adjusted OR, 39.8; 95 % CI, 10.1-189.1). There were no significant difference between women with rASRM I-III endometriosis and women without endometriosis. CONCLUSIONS: We found that the frequencies of preterm birth and placenta previa were significantly increased in women with endometriosis, and the severity of endometriosis might have an adverse impact on ART pregnancy.

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Outcome instruments

rASRM

Condition tags

endometriosis

MeSH descriptors

Endometriosis Pregnancy Complications Reproductive Techniques, Assisted Adult Endometriosis Endometriosis Female Humans Placenta Previa Placenta Previa Pregnancy Pregnancy Complications Premature Birth Premature Birth Retrospective Studies Risk Factors

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