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Review
. 2023 Nov 7;21(1):107.
doi: 10.1186/s12958-023-01157-8.

Endometriosis and IVF treatment outcomes: unpacking the process

Edgardo Somigliana  1   2 , Letizia Li Piani  3 , Alessio Paffoni  4 , Noemi Salmeri  5 , Michele Orsi  2 , Laura Benaglia  2 , Paolo Vercellini  1   2 , Paola Vigano'  6
Affiliations
Review

Endometriosis and IVF treatment outcomes: unpacking the process

Edgardo Somigliana et al. Reprod Biol Endocrinol. .

Abstract

Advanced endometriosis is associated with a reduction of IVF success. Surgical damage to the ovarian reserve following the excision of endometriomas has been claimed as a critical factor in the explanation of this detrimental effect. However, it is generally inferred that other mechanisms might also hamper IVF success in affected women. They include diminished responsiveness to ovarian stimulation, altered steroidogenesis, a decline in oocyte quality, reduced fertilization and embryo development, and impaired implantation. To navigate these limitations, we scrutinized available literature for studies specifically designed to address distinct phases of the IVF process. Utmost consideration was given to intra-patient ovarian response comparisons in women with unilateral endometriomas and to studies applying a meticulous matching to control confounders. The following observations have been drawn: 1) endometriosis has a negligible impact on ovarian response. A slight reduction in stimulation response can only be observed for endometriomas larger than 4 cm. Follicular steroidogenesis is unaffected; 2) oocyte quality is not hampered. Fertilization rates are similar, and intracytoplasmic sperm injection (ICSI) is not justified. Embryonic development is uncompromised, with no increase in aneuploidy rate; 3) endometrial receptivity is either unaffected or only slightly impacted. In conclusion, our study suggests that, aside from the well-known negative effect on ovarian reserve from excisional endometrioma surgeries, endometriosis does not significantly affect IVF outcomes.

Keywords: ART; Embryo; Endometrioma; Endometriosis; IVF; Implantation; Oocyte.

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Conflict of interest statement

E.S. declares honoraria and grants from Theramex, Merck-Serono and Ferring. P.V. is a Section Editor of Reproductive Biology and Endocrinology. All the other authors have nothing to declare.

Figures

Fig. 1
Fig. 1
Key confounders in different steps of the IVF procedure that could influence study results on the impact of endometriosis. WOI: Window of Implantation; ICSI: Intracytoplasmic sperm injection
Fig. 2
Fig. 2
Box and whiskers plot of the number of follicles, oocytes retrieved, suitable oocytes, 2PN (fertilized oocytes), cleavage embryos and good quality embryos. Data from women with and without endometriosis are represented in red and green, respectively. A statistically significant difference emerged only for the number of oocytes retrieved (highlighted with an asterisk)
See this image and copyright information in PMC

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