Comparative effectiveness of infertility treatment using assisted reproductive technologies in patients with various forms of endometriosis and its combination with polycystic ovary syndrome

Makolkin A.A. Makolkin, А. С. Калугина
In: Journal of obstetrics and women's diseases · 2022 · vol. 71(1) , pp. 35–46 · doi:10.17816/jowd72255 · W4220743212
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⚙ AI-generated summary by claude@2026-06, 2026-06-06 ⓘ

This study found that minimal endometriosis does not affect ART outcomes, while severe endometriosis and its combination with PCOS negatively impact ART effectiveness, particularly with antGnRH stimulation protocols.

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

This retrospective study compared ART outcomes across 241 fresh-cycle stimulation cycles in women with histologically confirmed endometriosis (85 cycles), endometriosis combined with PCOS (53 cycles), and a tuboperitoneal infertility comparison group (103 cycles), stratifying endometriosis by ASRM stage into stages I–II (A1) and III–IV (A2). The key findings were that stage I–II endometriosis with GnRH-a stimulation had the highest pregnancy rate per embryo transfer and higher live birth rate, whereas stage III–IV endometriosis showed the lowest pregnancy rate with antGnRH stimulation; the authors also report that pregnancies in the antGnRH arms terminated in both A1 and A2. A major limitation explicitly noted is the small number of cases, which the authors state requires further research. This paper is centrally about endometriosis — it evaluates how endometriosis severity and ovarian stimulation protocol (GnRH-a vs antGnRH), including with concomitant PCOS, affect ART outcomes.

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Abstract

AIM: The purpose of this study is to investigate the influence of various forms of endometriosis and its combination with PCOS on the outcome of assisted reproductive technology programs (ART) with relation to ovarian stimulation. MATERIALS AND METHODS: During a retrospective examination, we analyzed the results of 241 ART cycles. All patients were divided into three groups: group A: endometriosis (85 ART cycles); group B: combination with PCOS (53 ART cycles), comparison group with tuboperitoneal infertility (103 ART cycles). Group A was subdivided into subgroup A1 with stage I / II endometriosis (50 cases, 58.82%) and subgroup A2 with stage III / IV endometriosis (35 cases, 41.18%). At the first stage of the study, we evaluated the anamnesis and the results of clinical and laboratory tests. During the second stage, we performed laparo- and hysteroscopy surgeries and determined the stage of endometriosis as well as the presence of concomitant pathologies. At the third stage, we performed infertility treatment using ART. RESULTS: The highest FSH dose was employed in group A2 with the ovarian stimulation performed with GnRH-a: 2230.80 614.09 IU. The minimal dose was used for group A1 (stimulation with antGnRH): 1171.43 547.42 IU. The highest pregnancy rate per embryo transfer (PR) was detected in group A1 with the use of GnRH-a (50%,) higher than in the comparison group (42.72%). The minimal PR (14.29%) was found in group A2 (stimulation with antGnRH). Live Birth Rate (LBR) was higher in A1 patients stimulated with GnRH-a (40.48%), while with the use of antGnRH, all pregnancies terminated in both groups A1 and A2. CONCLUSIONS: Our study confirmed that common forms of endometriosis are associated with a decrease in the effectiveness of infertility treatment using ART, but minimal forms of endometriosis do not affect the outcomes of ART cycles. The study revealed a negative impact of an ovarian stimulation protocol with the use of antGnRH on IVF outcomes including patients with the combination of endometriosis and PCOS. However, the small number of cases studied dictates further research to be conducted in this field.

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endometriosisinfertility

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