Is endometriosis typology a potentially better classification system for  assessing risk of female infertility?

Karen C Schliep; Anna Z Pollack; Leslie V Farland; May Shaaban; Bin Yan; Jing Wang; Lina Ghabayen; Rachael B Hemmert; Joseph B Stanford; C Matthew Peterson

doi:10.1016/j.xfre.2024.08.009

Endometriosis · Fertility and Outcomes

Is endometriosis typology a potentially better classification system for assessing risk of female infertility?

Schliep KC, Pollack AZ, Farland LV, Shaaban M, Yan B, Wang J, Ghabayen L, Hemmert RB, Stanford JB, Peterson CM

Published December 2024 F&S Reports, 5(4), 394-401

DOI 10.1016/j.xfre.2024.08.009 PMID 39781080 PMC PMC11705600

RRM Academy Synopsis

Deep or ovarian endometriosis is associated with longer time to pregnancy

In a prospective study of 473 women having surgery, deep or ovarian endometriosis was associated with a longer wait to get pregnant. The 198 women with planned pregnancies supplied the timing. Among them, superficial endometriosis showed no clear association.

Key Findings

Of 473 women, 116 (25%) had superficial endometriosis (SE) only, 29 (6%) deep infiltrating endometriosis (DIE), 23 (5%) ovarian endometriomas (OE), and 22 (5%) both DIE and OE.
Among 198 women with planned pregnancies, mean time to pregnancy was 4.2 months (95% CI, 3.18–5.22) with DIE and/or OE, 3.55 months with SE, and 2.85 months with no endometriosis.
Ever using infertility treatment: adjusted prevalence ratio 2.61 (95% CI, 1.82–3.74) for DIE and/or OE and 1.36 (95% CI, 0.89–2.09) for SE, compared with no endometriosis.

Interpretation

This cohort study followed 473 women who had surgery for endometriosis. Among 198 women who were planning a pregnancy, deep or ovarian endometriosis was linked with a longer wait to conceive and with more use of infertility treatment, compared with women who had no endometriosis. Superficial endometriosis showed a smaller link to infertility treatment and no clear link to time to pregnancy. The authors note they had limited power to study these subtypes among women planning pregnancy. The findings support larger studies of time to pregnancy by endometriosis type.

RRM Context

The authors found that lesion type tracked with infertility better than the standard staging system did. Restorative reproductive medicine asks where disease is and what type it is, before treatment begins.

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

Abstract

Objective

To determine whether endometriosis typology, namely ovarian endometriomas (OE), deep infiltrating endometriosis (DIE), or superficial endometriosis (SE), correlates with fertility history.

Design

Prospective cohort.

Setting

One of fourteen surgical centers in Salt Lake City, Utah (n = 5) or San Francisco, California (n = 9).

Patients

A total of 473 women (18-44 years) with no prior endometriosis diagnosis, undergoing laparoscopies/laparotomies, irrespective of indication, in Utah or California (2007-2009).

Exposure

Incident endometriosis.

Main Outcome Measures

Before surgery, we queried women about time to become pregnant for prior planned pregnancies. Generalized linear models were used to calculate adjusted prevalence ratios (aPR) for association between endometriosis typology and infertility, defined as having ever tried >12 months (>6 months for women ≥35 years) to get pregnant. We also generated fecundability odds ratios (aFOR) to capture time to pregnancy.

Results

Twenty-five percent (n = 116) of women were diagnosed with SE only, 5% (n = 23) with OE, 6% (n = 29) with DIE, and 5% (n = 22) with OE + DIE, and 60% (n = 283) with no endometriosis. Compared with women with no endometriosis, women with SE had a 1.58 higher aPR (95% confidence interval [CI], 1.16-2.14), although women with OE and/or DIE had a 2.41 higher aPR for subfertility after adjusting for women's age, body mass index, and site. Compared with women with no endometriosis, women with OE and/or DIE had a 53% lower historic fecundability (aFOR, 0.47; 95% CI, 0.24-0.95); however, no association was found among women with SE (aFOR, 0.81; 95% CI, 0.49-1.33).

Conclusions

Specific endometriosis typologies may be associated with fecundability, with OE and/or DIE associated with nearly a 150% higher prevalence of subfertility and over a 50% lower historic fecundability.

Topics

Endometriosis Fertility and Outcomes Ovarian Reserve

Endometriosis › Fertility and Outcomes › Ovarian Reserve

Karen C Schliep, Anna Z Pollack, Leslie V Farland, May Shaaban, Bin Yan, Jing Wang, Lina Ghabayen, Rachael B Hemmert, Joseph B Stanford, C Matthew Peterson

K Schliep, A Pollack, L Farland, M Shaaban, B Yan, J Wang, L Ghabayen, R Hemmert, Joe Stanford, Joey Stanford, J Stanford

PMID 39781080 39781080 DOI 10.1016/j.xfre.2024.08.009 10.1016/j.xfre.2024.08.009 Schliep et al. 2024, Schliep 2024