Barnhart, K., Dunsmoor-Su, R., & Coutifaris, C. (2002). Effect of endometriosis on in vitro fertilization. Fertility and Sterility, 77(6), 1148-1155. https://doi.org/10.1016/s0015-0282(02)03112-6
Barnhart K, Dunsmoor-Su R, Coutifaris C. Effect of endometriosis on in vitro fertilization. Fertil Steril. 2002;77(6):1148-1155. doi:10.1016/s0015-0282(02)03112-6
Barnhart, Kurt, et al. "Effect of endometriosis on in vitro fertilization." Fertility and Sterility, vol. 77, no. 6, 2002, pp. 1148-1155.
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Endometriosis is linked to lower IVF pregnancy odds in 22 studies
A 2002 meta-analysis of 22 studies found that women with endometriosis had lower odds of pregnancy after IVF than women with tubal factor infertility (odds ratio 0.56 after adjustment). Severe disease had lower odds than mild disease before adjustment.
Key Findings
The analysis pooled 22 studies covering 2,377 IVF cycles in women with endometriosis and 4,383 IVF cycles in women without endometriosis.
Adjusted for age, publication year and stimulation regimen, women with endometriosis only had lower odds of pregnancy than women with tubal factor only (odds ratio 0.56; 95% CI 0.44–0.70).
Against tubal factor controls, stage III or IV endometriosis had an adjusted pregnancy odds ratio of 0.46 (95% CI 0.28–0.74). Stage I or II had 0.79 (95% CI 0.60–1.03).
Comparing stage III or IV with stage I or II directly, the unadjusted pregnancy odds ratio was 0.60 (95% CI 0.42–0.87). The adjusted odds ratio was 0.64 (95% CI 0.35–1.17).
In the all-patient comparison, adjusted odds ratios were 0.87 (95% CI 0.85–0.88) for fertilization, 0.86 (95% CI 0.85–0.88) for implantation and 0.92 (95% CI 0.85–0.99) for oocytes retrieved.
Interpretation
The study is a meta-analysis of observational IVF studies, searched through May 1999. No pooled study was a randomized trial. The outcome was a positive hCG pregnancy test, the only pregnancy measure comparable across all studies. Before adjustment, women with endometriosis had more oocytes retrieved. After adjustment, they had fewer. The studies did not consistently report prior treatment of endometriosis, so the authors drew no conclusion about whether treating it first changes IVF results. Miscarriage and multiple birth were not assessed.
RRM Context
IVF proceeds without removing the disease. In the all-patient comparison, endometriosis was associated with lower odds at each step the authors measured. Those steps ran from oocytes retrieved to fertilization and implantation. The pattern suggests the disease continues to matter after IVF begins. RRM treats endometriosis itself, and excision removes the lesions.
Our editorial summary of this paper, not the article's abstract.
Abstract
Objective
To investigate the IVF outcome for patients with endometriosis.
Design
Meta-analysis.
Setting
Academic research center.
Patients
A MEDLINE search and review of the literature were performed. Patients were classified by level of endometriosis, and controls were classified according to the indication for IVF.
Interventions
Bivariate analysis and multivariate logistic regression was used to estimate overall effect and control for confounding.
Main Outcome Measures
Pregnancy rates, fertilization rate, implantation rates, and numbers of oocytes retrieved.
Results
Twenty-two published studies were included in the overall analysis. The chance of achieving pregnancy was significantly lower for endometriosis patients (odds ratio, 0.56; 95% confidence interval, 0.44-0.70) when compared with tubal factor controls. Multivariate analysis also demonstrated a decrease in fertilization and implantation rates, and a significant decrease in the number of oocytes retrieved for endometriosis patients. Pregnancy rates for women with severe endometriosis were significantly lower than for women with mild disease (odds ratio, 0.60; 95% confidence interval, 0.42-0.87).
Conclusions
Patients with endometriosis-associated infertility undergoing IVF respond with significantly decreased levels of all markers of reproductive process, resulting in a pregnancy rate that is almost one half that of women with other indications for IVF. These data suggest that the effect of endometriosis is not exclusively on the receptivity of the endometrium but also on the development of the oocyte and embryo.
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