Endometriosis, Ovarian Reserve and Live Birth Rate Following In Vitro Fertilization/Intracytoplasmic Sperm Injection

To evaluate whether women with endometriosis have different ovarian reserves and reproductive outcomes when compared with women without this diagnosis undergoing in vitro fertilization/intracytoplasmic sperm injection ( IVF/ ICSI), and to compare the reproductive outcomes between women with and without the diagnosis considering the ovarian reserve assessed by antral follicle count ( AFC ).

Methods

This retrospective cohort study evaluated all women who underwent IVF/ ICSI in a university hospital in Brazil between January 2011 and December 2012. All patients were followed up until a negative pregnancy test or until the end of the pregnancy. The primary outcomes assessed were number of retrieved oocytes and live birth. Women were divided into two groups according to the diagnosis of endometriosis, and each group was divided again into a group that had AFC 6 (poor ovarian reserve) and another that had AFC 7 (normal ovarian reserve). Continuous variables with normal distribution were compared using unpaired t-test, and those without normal distribution, using Mann-Whitney test. Binary data were compared using either Fisher's exact test or Chi-square ⁽²⁾ test. The significance level was set as p < 0.05.

Results

787 women underwent IVF/ICSI (241 of which had endometriosis). Although the mean age has been similar between women with and without the diagnosis of endometriosis (33.8 4 versus 33.7 4.4 years, respectively), poor ovarian reserves were much more common in women with endometriosis (39.8 versus 22.7%). The chance of achieving live birth was similar between women with the diagnosis of endometriosis and those without it (19.1 versus 22.5%), and also when considering only women with a poor ovarian reserve (9.4 versus 8.9%) and only those with a normal ovarian reserve (25.5 versus 26.5%).

Conclusions

Women diagnosed with endometriosis are more likely to have a poor ovarian reserve; however, their chance of conceiving by IVF/ICSI is similar to the one observed in patients without endometriosis and with a comparable ovarian reserve.

Keywords:
endometriosis; ovarian reserve; assisted reproduction; IVF; ICSI

Parameter	Endometriosis			Control
	Mean	SD	N	Mean	SD	N	p*
Age	34.4	4.3	241	34.5	4.5	546	0.7
BMI	24.2	4.0	225	25.1	4.2	525	0.01
	Median	IQR	N	Median	IQR	N	p**
AFC	8.0	4–13	233	12.0	7–20	509	< 0.001
Number of oocytes retrieved	4.0	2–8	241	6.0	3–10	546	< 0.001
	%	n	N	%	n	N	p***
Proportion of women with AFC ≤ 6	39.8%	96	241	22.7%	124	546	< 0.001
Cycle cancelled - poor response	6.2%	15	241	2.7%	15	546	0.03
Underwent OR	92.5%	223	241	97.1%	530	546	0.007
Underwent ET	77.2%	186	241	83.2%	454	546	0.06
Women with surplus embryos	32.0%	77	241	42.1%	230	546	0.007
Clinical pregnancy	22.4%	54	241	27.5%	150	546	0.2
Live birth	19.1%	46	241	22.5%	123	546	0.3
COS
FSH + Ant	63.1%	152	241	72.7%	397	546	0.01
FSH + Ago	22.8%	55	241	19.4%	106	546
CC + FSH + Ant	14.1%	34	241	7.9%	43	546

Parameter	Endometriosis			Control
	Mean	SD	N	Mean	SD	N	p*
Age	35.2	4.5	96	37.3	3.6	124	< 0.001
BMI	24.2	4.4	90	24.4	4.2	119	0.8
	Median	IQR	N	Median	IQR	N	p**
AFC	3.5	3.0–5.0	96	5.0	3.3–6.0	124	< 0.001
Number of oocytes retrieved	2.00	0.3–4.8	96	3.0	1.0–5.0	124	0.2
	%	n	N	%	n	N	p***
Cycle cancelled - poor response	11.5%	11	96	7.3%	9	124	0.4
Underwent OR	87.5%	84	96	92.7%	115	124	0.3
Underwent ET	65.6%	63	96	66.1%	82	124	1.0
Women with surplus embryos	14.6%	14	96	14.5%	18	124	1.0
Clinical pregnancy	11.5%	11	96	13.7%	17	124	0.7
Live birth	9.4%	9	96	8.9%	11	124	1.0
COS
FSH + Ant	52.1%	50	96	69.4%	86	124	0.03
FSH + Ago	17.7%	17	96	10.5%	13	124
CC + FSH + Ant	30.2%	29	96	20.2%	25	124

Parameter	Endometriosis			Control
	Mean	SD	N	Mean	SD	N	p*
Age	33.8	4.0	145	33.7	4.4	422	0.7
BMI	24.2	3.8	135	25.4	4.2	406	0.01
	Median	IQR	N	Median	IQR	N	p**
AFC	12.0	9.0–17.5	137	15.0	10.0–22.0	385	< 0.001
Number of oocytes retrieved	6.0	3.0–10.0	145	7.0	4.75–11.0	422	0.02
	%	n	N	%	n	N	p***
Cycle cancelled - poor response	2.8%	4	145	1.4%	6	422	0.3
Underwent OR	95.9%	139	145	98.3%	415	422	0.1
Underwent ET	84.8%	123	145	88.2%	372	422	0.3
Women with surplus embryos	43.4%	63	145	50.2%	212	422	0.2
Clinical pregnancy	29.7%	43	145	31.5%	133	422	0.8
Live birth	25.5%	37	145	26.5%	112	422	0.9
COS
FSH + Ant	70.3%	102	145	73.7%	311	422	0.6
FSH + Ago	26.2%	38	145	22.0%	93	422
CC + FSH + Ant	3.4%	5	145	4.3%	18	422

Federação Brasileira das Sociedades de Ginecologia e Obstetrícia Av. Brigadeiro Luís Antônio, 3421, sala 903 - Jardim Paulista, 01401-001 São Paulo SP - Brasil, Tel. (55 11) 5573-4919 - Rio de Janeiro - RJ - Brazil
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[1] Address for correspondence Paula Andrea Navarro, MD, PhD, Departmento de Ginecologia e Obstetrícia, Faculdade de Medicina de Ribeirão Preto, Hospital das Clínicas de Ribeirão Preto, Centro de Reprodução Humana, Universidade de São Paulo, Avenida Bandeirantes, 3.900, 8o andar, Ribeirão Preto, caixa postal: 14048-900, Ribeirão Preto, SP, Brazil (e-mail: pnavarro@fmrp.usp.br).