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Meta-Analysis
. 2024 Jan 2;7(1):e2354249.
doi: 10.1001/jamanetworkopen.2023.54249.

Live Birth After Oocyte Donation In Vitro Fertilization Cycles in Women With Endometriosis: A Systematic Review and Meta-Analysis

Alessio Paffoni  1 , Maíra Casalechi  2 , Dominique De Ziegler  3 , Ettore Cicinelli  4 , Edgardo Somigliana  5 , Paola Viganò  5 , Amerigo Vitagliano  4
Affiliations
Meta-Analysis

Live Birth After Oocyte Donation In Vitro Fertilization Cycles in Women With Endometriosis: A Systematic Review and Meta-Analysis

Alessio Paffoni et al. JAMA Netw Open. .

Abstract

Importance: Although multiple mechanisms have been proposed to explain the infertility related to endometriosis, there are no conclusive data on the association of endometriosis with endometrial receptivity. The oocyte donation model in assisted reproduction technology (ART) cycles can clarify this issue.

Objective: To explore the association of a history of endometriosis with ART outcomes in recipients of oocyte donation.

Data sources: In this systematic review and meta-analysis, electronic databases were searched from inception until August 31, 2023, using combinations of relevant keywords. Moreover, we retrieved data from the databases of the Society for Assisted Reproductive Technology (SART) in the US and the Human Fertilization and Embryology Authority (HFEA) in the United Kingdom.

Study selection: Observational studies were included if they investigated the impact of endometriosis on ART outcomes with donor oocytes.

Data extraction and synthesis: Publicly available data related to ART from various sources were gathered, and a retrospective aggregate and nonaggregate analysis using registries of in vitro fertilization cycles with oocyte or embryo donation was conducted.

Main outcomes and measures: The primary outcome was live birth rate (LBR) following oocyte donor cycles. The effect measures of comparisons between groups are presented as odds ratios (ORs) with a 95% CI.

Results: This study analyzed 7212 oocyte donation cycles from 4 studies for the meta-analysis, along with 162 082 cycles from 2 registries (137 182 from SART and 24 900 from HFEA). No significant differences between the groups were observed in the meta-analysis of published data after adjusting for confounding factors (OR, 0.54; 95% CI, 0.19-1.57). A statistically significant lower LBR was identified in women with endometriosis when analyzing the aggregate data from SART and HFEA databases (OR, 0.89; 95% CI, 0.81-0.97).

Conclusions and relevance: This study found a modest decrease in LBR among women with a history of endometriosis, although only results from the pooled analysis of registry data and not those from the meta-analysis reached statistical significance. These findings suggest that a marginal impairment of uterine receptivity may contribute to infertility mechanisms in women affected by endometriosis.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Somigliana reported receiving grants from Ferring and Ibsa and personal fees from Ibsa and Gedeon Richter during the conduct of the study. Dr Viganò reported being co–Editor in Chief of the Journal of Endometriosis and Uterine Disorders. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Forest Plots for Live Birth Rate for Unadjusted and Adjusted Analysis Between Women With and Without a History of Endometriosis as Recipients of Egg Donation Assisted Reproductive Technology Cycles
Data from published studies and those from registries (Society for Assisted Reproductive Technology [SART] and Human Fertilization and Embryology Authority [HFEA]) were pooled separately. Squares in panel A refer to dichotomous variables. Squares in panel B indicate the inclusion of log odds ratio and the SE of the log odds ratio in the meta-analysis. Size of the squares depends on the weight assigned to each study in the analysis. Diamonds denote the overall effect estimates; the width of the diamond indicates the 95% CI around the combined effect. aRefers to unadjusted data or source in which adjustment was not possible.
Figure 2.
Figure 2.. Forest Plots for Implantation Rate for Unadjusted and Adjusted Analysis Between Women With and Without a History of Endometriosis as Recipients of Egg Donation Assisted Reproductive Technology Cycles
Data from published studies and those from registries (Society for Assisted Reproductive Technology [SART] and Human Fertilization and Embryology Authority [HFEA]) were pooled separately. Squares in panel A refer to dichotomous variables. Squares in panel B indicate the inclusion of log odds ratio and the SE of the log odds ratio in the meta-analysis. Size of the squares depends on the weight assigned to each study in the analysis. Diamonds denote the overall effect estimates; the width of the diamond indicates the 95% CI around the combined effect. aRefers to unadjusted data or source in which adjustment was not possible.
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