Endometriosis may lower egg and embryo quality, a review finds
A 2023 review of studies published from 1991 to 2022 concludes that endometriosis may lower egg and embryo quality. The authors link endometriosis to fewer eggs retrieved in IVF and see no clear effect on live birth after IVF. The review centers on women having IVF.
Study at a glance: Endometriosis may lower egg and embryo quality. Source: Latif S et al., 2023, PMID 37445220.
Key Findings
Recipients with endometriosis using donor eggs from healthy women had implantation and pregnancy rates equivalent to those without it. Donor eggs from stage III and IV donors showed significantly reduced implantation.
Among 25,000 blastocysts from IVF with pre-implantation genetic screening, aneuploidy rates did not differ between women with and without endometriosis when stratified for age.
In 347,185 SART IVF cycles, endometriosis went with lower live birth, alongside other diagnoses. In a small endometriosis-alone group, live birth was similar or slightly higher than other diagnoses.
A Latin American registry found fewer oocytes retrieved and more cancellations, without reduced pregnancy or live birth rates. In 13,614 HFEA endometriosis cycles, donor-egg and own-egg live birth did not differ significantly.
The review found no randomized controlled trials of surgery for women having IVF. A meta-analysis in deep infiltrative endometriosis suggested a possible benefit, though accuracy and loss to follow up raised concern.
Interpretation
The authors searched PubMed and describe the studies one by one, without pooling results. The majority of studies were small and measured different signs of egg quality. Some evidence is indirect, drawn from follicular fluid or embryo grade, which the male partner also influences. The review focuses on women having IVF, and conception without IVF is not its subject. The text does not mention excision or ablation.
RRM Context
IVF retrieves eggs and transfers embryos. Its outcomes describe what happens after the reproductive system is bypassed. The authors list proposed mechanisms of infertility in endometriosis, including distorted pelvic anatomy and impaired transport of eggs and embryos. Restorative reproductive medicine asks why conception fails and treats that cause.
Our editorial summary of this paper, not the article's abstract.
Abstract
Endometriosis is a common finding among women with infertility, and women who are diagnosed with endometriosis are almost twice as likely to experience infertility. Mechanisms by which endometriosis causes infertility remain poorly understood. In this review, we evaluate the current literature on the impact of endometriosis on oocyte and embryo quality. The presence of endometriosis evidently reduces ovarian reserve, oocyte quality, and embryo quality; however, this does not appear to translate to a clear clinical impact. Analysis of data from large assisted reproduction technology registries has shown that women with endometriosis have a lower oocyte yield but no reduction in reproductive outcomes. There is a need for future studies in the form of well-designed randomized controlled trials to further evaluate the role of surgical and medical treatment options in women with endometriosis undergoing assisted conception.
