Researchers in a 2022 study performed a systematic review and meta-analysis on women with endometriosis undergoing IVF and found no change in live birth rates, but an increased risk of obstetric and perinatal outcomes, however patients were diagnosed without laparoscopy and didn’t account for treated patients.
Endometriosis is a condition where cells of the endometrium grow outside the uterus and can lead to inflammation and the formation of cysts. Studies have often found a negative association between endometriosis and IVF outcomes.
Qu et al. (2022) performed a systematic review and meta-analysis to combine 70 studies on the impact of endometriosis on IVF and obstetric and perinatal outcomes that spanned studies conducted up to August 2021. Patients were diagnosed with endometriosis by ultrasound or MRI, which can be less reliable than other methods like laparoscopy. They also didn’t account for surgical or medical treatments for patients. These are limitations and make it less clear if endometriosis is truly being represented in this meta-analysis.
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Table of Contents
Live birth rate and endometriosis
Based on 25 studies and 344,522 participants, there was no statistically significant difference in live birth rates in women with endometriosis compared to those without it (37.3% vs 35.5%, odds ratio [95%] CI: 0.90 [0.80-1.02]).
Another analysis compared women with stage 3 to 4 (moderate to severe) endometriosis. Based on 4 studies and 1,524 participants, there was no statistically significant difference in live birth rates in women with stage 3-4 endometriosis compared to those without endometriosis (32.1% vs 56.0%, odds ratio [95%] CI: 0.67 [0.18-2.56]).
Implantation rate and endometriosis
Based on 31 studies and 19,204 participants, there was a statistically significant decrease in implantation rates in women with endometriosis compared to those without it (20.1% vs 20.6%, odds ratio [95%] CI: 0.84 [0.71-0.98]). This means that women with endometriosis had a 16% decrease in the odds of implantation compared to women without it.
Number of eggs retrieved and endometriosis
Based on 26 studies and 15,764 participants, there was a statistically significant decrease in the number of eggs retrieved from women with endometriosis compared to those without it (average difference [95%] CI: -1.51 [-2.06 – -0.95]). This means that women with endometriosis had on average 1.51 fewer eggs retrieved compared to women without it.
Obstetric and perinatal outcomes and endometriosis
Preterm birth rate
Based on 6 studies and 17,800 participants, there was no statistically significant difference in the rate of preterm birth from women with endometriosis compared to those without it (12.0% vs 8.8%, odds ratio [95%] CI: 1.21 [0.91-1.61]).
Placenta previa rate
Based on 4 studies and 8,038 participants, there was a statistically significant increase in the rate of placenta previa from women with endometriosis compared to those without it (4.3% vs 2.1%, odds ratio [95%] CI: 3.11 [1.10-8.76]). This means that women with endometriosis were 3.11 times more likely in the odds of having placenta previa compared to those without it.
Preeclampsia rate
Based on 3 studies and 1,223 participants, there was no statistically significant difference in the rate of preeclampsia from women with endometriosis compared to those without it (2.8% vs 4.0%, odds ratio [95%] CI: 0.88 [0.12-6.30]).
Ectopic pregnancy rate
Based on 12 studies and 303,732 participants, there was a statistically significant increase in the rate of ectopic pregnancies from women with endometriosis compared to those without it (0.92% vs 0.79%, odds ratio [95%] CI: 1.16 [1.04-1.31]). This means that women with endometriosis were 16% more likely in the odds of having an ectopic pregnancy compared to those without it.
Postpartum hemorrhage rate
Based on 2 studies and 6,956 participants, there was a statistically significant increase in the rate of postpartum hemorrhage from women with endometriosis compared to those without it (12.7% vs 10.6%, odds ratio [95%] CI: 1.25 [1.04-1.50]). This means that women with endometriosis were 25% more likely in the odds of having an postpartum hemorrhage compared to those without it.
Multiple pregnancy rate
Based on 8 studies and 9,285 participants, there was a statistically significant increase in the rate of multiple pregnancies from women with endometriosis compared to those without it (20.4% vs 17.5%, odds ratio [95%] CI: 1.21 [1.07-1.36]). This means that women with endometriosis were 25% more likely in the odds of having a multiple pregnancy compared to those without it.
Rate of babies small for gestational age
Based on 4 studies and 2,875 participants, there was no statistically significant difference in the rate of babies that were small for gestational age from women with endometriosis compared to those without it (13.8% vs 12.0%, odds ratio [95%] CI: 1.14 [0.90-1.44]).
Rate of severe neonatal problems
Based on 2 studies and 704 participants, there was no statistically significant difference in the rate of babies with severe neonatal problems from women with endometriosis compared to those without it (2.6% vs 1.7%, odds ratio [95%] CI: 1.52 [0.53-4.32]).
Conclusions
In this study, they found that women with endometriosis had statistically significant differences in:
- Implantation rate (decreased)
- Number of eggs retrieved (decreased)
- Placenta previa (increased)
- Ectopic pregnancy (increased)
- Postpartum hemorrhage (increased)
- Multiple pregnancies (increased)
They found that there were no statistically significant differences in:
- Live birth rate, even in those with severe endometriosis (stage 3-4)
- Preterm birth rate
- Preeclampsia rate
- Rate of babies small for gestational age
- Rate of severe neonatal problems
Limitations include that they didn’t account for different surgical or medical interventions used to treat endometriosis, as well as differences in the diagnosis of the control groups. Additionally, patients were diagnosed with endometriosis by ultrasound or MRI, which can be less reliable than other methods like laparoscopy.
The authors conclude that while there was no difference in live birth rates in women with endometriosis, there was an increase in obstetric and perinatal risks, so patients should be monitored more closely during pregnancy.
Reference
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About Embryoman
Embryoman (Sean Lauber) is a former embryologist and the founder of Remembryo, an IVF research and fertility education website. After working in an IVF lab in the US, he returned to Canada and now focuses on making fertility research more accessible. He holds a Master’s in Immunology and launched Remembryo in 2018 to help patients and professionals make sense of IVF research. Sean shares weekly study updates on Facebook, Instagram, and Reddit regularly. He also answers questions on Reddit or in his private Facebook group.
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