Implications of the diagnosis of endometriosis on the success of infertility treatment

PURPOSE: Endometriosis is a clinically very heterogeneous disorder and its implications on the resolution of infertility are not clear. METHODS: Clinical data of 783 consecutive infertile couples were retrospectively analyzed in three groups: A--with minimal/mild endometriosis: B--with moderate/severe endometriosis; C--without endometriosis. Subgroups of groups A and C with unexplained infertility were also compared. RESULTS: Endometriosis was found in 349 patients (44.6%)--263 in group A and 86 in group B. Group C comprised 434 patients. Overall pregnancy rates were 57.0% for group A, 48.8% for B and 55.8% for C (not statistically different). Of couples in groups A, B, C, respectively, 39.2%, 51.1% and 39.2% needed IVF (B vs C - p = 0.042; B vs A - p = 0.059). Of couples in group A 45.6% that underwent IVF achieved a pregnancy by this technique; corresponding numbers were 43.2% for group B and 46.5% for C. Overall pregnancy rates in couples with unexplained infertility in groups A (n = 116) and C (n = 110) were respectively, 58.6% and 56.4%; IVF was needed in 40.5% and 32.7% of those couples, and the cumulative pregnancy rates resulting from IVF were 40.4% and 47.2% (NS). CONCLUSION: The diagnosis of endometriosis had no influence on the successful resolution of infertility although moderate/severe endometriosis was related to a greater need for IVF. Couples with unexplained infertility had similar pregnancy rates either in the presence or in the absence of minimal/mild endometriosis.