How does endometriosis affect the outcomes of women utilizing assisted reproductive technology?

Updated: May 10, 2021
  • Author: G Willy Davila, MD; Chief Editor: Michel E Rivlin, MD  more...
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Some authorities believe that endometriosis should be suppressed prophylactically by continuous combined oral contraceptives, GnRH analogs, medroxyprogesterone, or danazol in order to cause regression of asymptomatic disease and enhance subsequent fertility. However, according to a Cochrane review, no benefit is derived from ovulation suppression in subfertile women with endometriosis who wish to conceive. [63]

A Cochrane review of interventions in women with endometriomata (cysts of endometriosis in the ovaries) before the use of assisted reproductive technology (ART) identified 4 trials with 312 participants could reach no conclusions regarding interventions for the management of endometriomata in women undergoing ART. [64]

In a 2015 systematic review and meta-analysis of the influence of endometriosis on ART outcomes from 36 studies (of 1346 articles), investigators found similar outcomes for live births between women with endometriosis who underwent in vitro fertilization and intracytoplasmic sperm injection and women without endometriosis. [65] However, women with severe endometriosis had lower live birth rates, clinical pregnancy rates, and mean number of retrieved oocyte relative to those without endometriosis. The investigators noted there remains not enough evidence to support recommending surgery routinely before women undergo ART. [65]

Surgical ablation of asymptomatic endometriosis has also been shown to improve fecundity rates on a 3-year follow-up. [61]

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