Endometriosis and Assisted Reproductive Technologies: Maximizing Outcomes

Eric S. Surrey, MD


Semin Reprod Med. 2013;31(2):154-163. 

In This Article

Does Endometriosis Affect IVF Outcome?

A controversial issue is whether endometriosis per se exerts a deleterious effect on IVF outcomes. If the primary effect of endometriosis on infertility is a fundamental effect on oocyte quality or implantation, then IVF would not be expected to have a benefit. Several early studies implied that fertilization, implantation, and pregnancy rates in endometriosis patients were significantly compromised in comparison with controls.[2–5] It is important to note that in these trials, outcomes were compromised in control groups as well. In contrast, Olivennes and colleagues reported a 30% delivery rate per embryo transfer in 360 IVF cycles performed on 214 endometriosis patients in contrast to a 37.5% rate in 166 cycles performed on 111 controls with tubal disease, a difference that was not statistically significant.[6] Others have confirmed these findings.[7,8]

Barnhart and coworkers performed a meta-analysis addressing this issue and included 27 trials published from 1983 to 1998.[9] The authors concluded that the chance of conceiving from IVF was significantly lower for endometriosis patients than for tubal factor controls (odds ratio [OR]: 0.56; 95% confidence interval [CI]: 0.44 to 0.70). They also reported that endometriosis patients experienced significantly lower fertilization and implantation rates with a lower number of oocytes obtained. Once again, mean implantation and pregnancy rates were low in both groups (12.72% versus 18.08%). Note that these outcome statistics do not generally reflect current practice.

A more recent large retrospective analysis concluded that live-birth rates were similar for patients with endometriosis and tubal factor infertility (66.0% versus 66.7%).[10] Both groups had poorer outcomes than those with unexplained infertility (78.8%). Nevertheless, implantation rates, a more accurate reflection of IVF outcome, were similar among all three groups. According to the 2010 SART registry, age-matched patients with endometriosis fared no differently than the overall population of women undergoing IVF (Table 1).