Association of endometriosis and spontaneous abortion: effect of control group selection

Deborah A. Metzger; David L. Olive; Gene F. Stohs; Robert R. Franklin

doi:10.1016/s0015-0282(16)49090-4

Research Methods Study Design

Association of endometriosis and spontaneous abortion: effect of control group selection

Metzger DA, Olive DL, Stohs GF, Franklin RR

Published January 1986 Fertility and Sterility, 45(1), 18-22

DOI 10.1016/s0015-0282(16)49090-4 PMID 3943647

RRM Academy Synopsis

Miscarriage fell after endometriosis diagnosis with or without surgery

Miscarriage rates fell after women with endometriosis were diagnosed, whether or not they had surgery. In a 1986 chart review of 139 infertile women, about 6 in 10 pregnancies ended in miscarriage before diagnosis. About 2 in 10 did with expectant management. None did after conservative surgery.

About 6 in 10 pregnancies ended in miscarriage before an endometriosis diagnosis. Source: Metzger DA et al., 1986, PMID 3943647.

Study at a glance, chart review: Miscarriage fell after endometriosis diagnosis with or without surgery — Study at a glance, chart review of 139 infertile women: Miscarriage fell after endometriosis diagnosis with or without surgery. Source: Metzger DA et al., 1986, PMID 3943647.

Key Findings

Before diagnosis, 41 of 65 pregnancies ended in spontaneous abortion (loss before 20 weeks' gestation), a rate of 63.1%.
After conservative surgical resection, 0 of 32 pregnancies ended in spontaneous abortion (0.0%), with no miscarriages at any stage of disease. The pooled comparison with before diagnosis gave P < 0.000001.
With expectant management, 6 of 32 pregnancies ended in spontaneous abortion (18.7%), well below the rate before diagnosis (P < 0.0001).
Expectant management rates were 16.7% (3 of 18 pregnancies) in mild and 21.4% (3 of 14) in moderate disease.
In mild and moderate disease, surgical and expectant groups did not differ significantly in spontaneous abortion rate. The difference reached significance only when all stages were pooled.

Interpretation

This chart review followed 139 infertile women with endometriosis. One doctor saw them in 1977. The review tracked pregnancies before diagnosis, with expectant management, and after conservative surgery. Severe disease had no pregnancies with expectant management. The findings support larger studies of endometriosis and pregnancy loss.

RRM Context

Endometriosis can occur with other problems linked to miscarriage. One example is low progesterone. Restorative reproductive medicine evaluates the whole cycle and both partners. A full workup checks for other treatable causes too.

Our editorial summary of this paper, not the article's abstract.

Abstract

Endometriosis has been associated with an increased incidence of spontaneous abortion, compared with the abortion rate of the general population. To assess whether a separate control group would affect these conclusions, we studied 139 consecutive infertility patients with laparoscopically proven endometriosis to determine the incidence of spontaneous abortion. Ninety-five of these patients underwent conservative surgical resection of endometriosis, and 44 patients opted for expectant management. There was no significant difference between these two groups in average age, duration of infertility, or proportion of patients with primary infertility. The average spontaneous abortion rate before diagnosis for all patients was 63.1%. After surgical treatment, the abortion rate dropped to 0% (P less than 0.000001) for all stages of disease. However, even in those patients who received expectant management only, the abortion rate fell to 16.7% and 21.4% for mild and moderate endometriosis, respectively (P less than 0.001). These results suggest that the spontaneous abortion rate in untreated endometriosis may not be as high as previously reported and may not be significantly different from the rate in the general population. The data also emphasize the need for well-defined control groups when assessing the effects of a treatment regimen.

Read the guides

Endometriosis Explained: Diagnosis, Excision Surgery, and the RRM Approach

Endometriosis is a chronic inflammatory disease that drives pain, organ dysfunction, and infertility. How RRM-trained clinicians diagnose and treat it through excision surgery, cycle charting, and longitudinal care.

22 min read
Miscarriage and Recurrent Pregnancy Loss: The Workup Most Women Never Get

Miscarriage affects approximately 15% of clinically confirmed pregnancies. Recurrent pregnancy loss (RPL), defined as two or more clinical losses, affects 2 to 5% of couples. Most causes are diagnosable and treatable. This guide covers what the standard workup misses, what RRM-trained clinicians evaluate, and what outcomes look like after cause-based treatment.

22 min read

Topics

Research Methods › Study Design › Cohort Studies · Endometriosis › Fertility and Outcomes › Conception After Excision · Pregnancy › Early Pregnancy › Miscarriage

Deborah A. Metzger, David L. Olive, Gene F. Stohs, Robert R. Franklin

Debbie Metzger, Deb Metzger, D Metzger, Dave Olive, D Olive, G Stohs, Bob Franklin, Rob Franklin, Bobby Franklin, R Franklin

PMID 3943647 3943647 DOI 10.1016/s0015-0282(16)49090-4 10.1016/s0015-0282(16)49090-4 Metzger et al. 1986, Metzger 1986

Keywords

Abortion, Spontaneous/etiology, Adult, Endometriosis/complications/surgery, Epidemiologic Methods, Female, Humans, Infertility, Female/etiology, Pregnancy

Association of endometriosis and spontaneous abortion: effect of control group selection

Miscarriage fell after endometriosis diagnosis with or without surgery

Key Findings

Interpretation

RRM Context

Abstract

Read the guides

Topics

By this author

Related research

Keywords