Endometriosis Lowers the Cumulative Live Birth Rates in IVF by Decreasing the Number of Embryos but Not Their Quality
Abstract
Endometriosis and infertility are closely linked, but the underlying mechanisms are still poorlyunderstood. This study aimed to evaluate the impact of endometriosis onin vitrofertilization (IVF)parameters, especially on embryo quality and IVF outcomes. A total of1124 cycleswith intracytoplasmicsperm injection were retrospectively evaluated,including 155 cycles with endometriosis and 969 cycleswithout endometriosis. Women with endometriosis had significantly lower ovarian reserve markers(AMH and AFC), regardless of previous ovarian surgery. Despite receiving significantly higher dosesof exogenous gonadotropins, they had significantly fewer oocytes, mature oocytes, embryos, andtop-quality embryos than women in the control group. Multivariate analysis did not reveal anyassociation between endometriosis and the proportion of top-quality embryo (OR=0.87; 95% CI[0.66–1.12];p=0.3). The implantation rate and the live birth rate per cycle were comparable betweenthe two groups (p=0.05), but the cumulative live births rate was significantly lower in in theendometriosis group (32.1% versus 50.7%,p=0.001), as a consequence of the lower number of frozenembryos. In conclusion, endometriosis lowers the cumulative live birth rates by decreasing thenumber of embryos available to transfer, but not their quality.