A new study published in Fertility and Sterility suggests that individuals diagnosed with deep infiltrating endometriosis or endometriomas through transvaginal ultrasound have a lower likelihood of achieving a live birth following their first in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) treatment.
While assisted reproductive technologies (ART) have been widely used to address infertility related to endometriosis, research findings on birth outcomes have been inconsistent. Variations in diagnostic approaches for endometriosis may have contributed to these mixed results.
To better understand the impact of endometriosis severity on IVF success, researchers conducted a prospective cohort study at the Reproductive Medical Center at Skate University Hospital in Malmö, Sweden. The study focused on individuals aged 25 to 39 years, all of whom were non-smokers with a body mass index (BMI) below 30 kg/m². Participants provided medical histories and detailed reports on endometriosis-related symptoms. Before undergoing treatment, they received transvaginal ultrasound examinations and serum anti-Müllerian hormone (AMH) testing to assess ovarian reserve.
The primary goal of the study was to determine the cumulative live birth rate after the first cycle of IVF or ICSI. Secondary objectives included evaluating ovarian reserve, IVF/ICSI outcomes, and live birth rates based on different endometriosis presentations. A total of 1,040 individuals participated in the study, with 115 diagnosed with endometriomas and 185 with deep infiltrating endometriosis. The analysis found no significant differences in age or BMI between those with and without these conditions. However, individuals with deep infiltrating endometriosis or endometriomas had lower median AMH levels and antral follicle counts, indicating reduced ovarian reserve.
The overall cumulative live birth rate for the total study population was 41.0%. Among individuals without deep infiltrating endometriosis or endometriomas, the live birth rate was slightly higher at 43.2%. In contrast, individuals with deep infiltrating endometriosis or endometriomas had a significantly lower live birth rate of 33.3%. When looking at specific subgroups, those with endometriomas but without deep infiltrating endometriosis had the lowest success rate, with only 24.5% achieving a live birth. Meanwhile, individuals with deep infiltrating endometriosis but without endometriomas had a slightly better live birth rate of 37.0%.
Compared to individuals without deep infiltrating endometriosis or endometriomas, those with these conditions had a 37% lower likelihood of live birth after the first IVF/ICSI cycle. The adjusted crude risk ratio for cumulative live birth was 0.63 (95% CI, 0.48-0.82). Furthermore, individuals with deep infiltrating endometriosis or endometriomas required significantly higher doses of follicle-stimulating hormone (FSH) for ovarian stimulation (2000 IU vs. 1750 IU, P = .024). However, no significant differences were found in the number of mature oocytes retrieved, fertilization rates, or the number of high-quality embryos produced.
The study had some limitations, including individualized treatment protocols, the exclusion of subsequent IVF/ICSI cycles beyond the first, and the absence of laparoscopic or histological confirmation of endometriosis. Ultimately, the findings suggest that deep infiltrating endometriosis and endometriomas—when diagnosed through transvaginal ultrasound using International Deep Endometriosis Analysis (IDEA) criteria—can significantly reduce the likelihood of live birth in the first cycle of IVF or ICSI. Despite comparable numbers of oocytes and high-quality embryos, these patients faced greater challenges in achieving successful pregnancies.
