Impact of Varying Stages of Endometriosis on the Outcome of In Vitro Fertilization–Embryo Transfer

Lubna Pal, L Pal, Jan L. Shifren, J L Shifren, K B Isaacson, Keith Isaacson, Yuchiao Chang, Y Chang, L Leykin, Lucy Leykin, T L Toth, Thomas L. Toth
Journal of assisted reproduction and genetics · 1998 · vol. 15(1) , pp. 27–31 · doi:10.1023/a:1022574221115 · PMID:9493063 · W2125812949
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⚙ AI-generated summary by claude@2026-06+body, 2026-06-07 ⓘ

This retrospective study found that while severe endometriosis impaired oocyte fertilization rates, the overall in vitro fertilization and embryo transfer outcomes remained comparable across different stages of the disease.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-07 · read from full text ⓘ

This retrospective academic study analyzed 85 IVF–embryo transfer cycles from 61 infertile patients with primary endometriosis, stratifying disease severity using the revised AFS classification into stages I/II (group A) versus III/IV (group B), while excluding factors such as age >40, high day-3 FSH, male-factor infertility, and assisted hatching. Across groups, the response to controlled ovarian hyperstimulation and the number, maturity, and quality of oocytes retrieved were comparable, but fertilization rates were significantly lower in the severe endometriosis group (stages III/IV). In contrast, implantation, clinical pregnancy, and miscarriage rates did not differ between severity groups. Limitations include its uncontrolled, retrospective design and the restricted inclusion criteria. This paper is centrally about endometriosis — specifically how increasing endometriosis stage affects oocyte fertilization versus overall IVF-embryo transfer outcomes.

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Abstract

Purpose: The impact of severity of endometriosis on the outcome of in vitro fertilization (IVF) was analyzed in an uncontrolled, retrospective study in an academic IVF program.

Methods

Sixty-one patients with a primary diagnosis of endometriosis undergoing 85 cycles of IVF were included in the study. Patients were divided according to the severity of disease based on the revised American Fertility Society (AFS) classification into groups A (stages I/II, or minimal/mild) and B (stages III/IV, or moderate/severe). Group A included 32 patients undergoing 45 IVF-embryo transfer (ET) cycles; group B included 29 patients undergoing 40 IVF cycles. Exclusion criteria were age older than 40 years, basal day 3 follicle stimulating hormone (FSH) greater than 20 IU/L, male-factor infertility, assisted hatching, and gamete intrafallopian transfer cases. Stimulation for IVF cycles was standard using pituitary down-regulation with gonadotropin-releasing hormone agonist in a midluteal protocol. Controlled ovarian hyperstimulation (COH) was achieved using a combination of FSH and human menopausal gonadotropin. Outcomes assessed included response to COH and number, maturity, and quality of oocytes retrieved. Fertilization, implantation, and pregnancy rates after IVF-ET were also analyzed.

Results

The response to COH and the number, maturity, and quality of the oocytes was comparable between patients with varying severity of endometriosis. Fertilization rates for oocytes of patients in group B (stages III/IV) were significantly impaired compared to those in group A (stages I/II) (P = 0,004). The rates for implantation, clinical pregnancy, and miscarriage were comparable between the two groups.

Conclusions

The reduced fertilization potential of the oocytes obtained from patients with severe endometriosis in the absence of male-factor infertility suggests an adverse biological impact of the advanced disease on the oocytes. The outcome of IVF-ET, however, is unaffected by increasing severity of endometriosis. This suggests that IVF may compensate for or overcome this reduction in the biological potential of the oocytes associated with severe disease, thus accounting for a comparable outcome irrespective of the severity of endometriosis. Similar content being viewed by others

References

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Condition tags

mesh:D004715endometriosis

MeSH descriptors

Embryo Transfer Endometriosis Fertilization in Vitro Adult Embryo Implantation Embryo Implantation Endometriosis Endometriosis Female Follicle Stimulating Hormone Follicle Stimulating Hormone Follicle Stimulating Hormone Humans Infertility Infertility Menotropins Menotropins Menotropins Oocytes Oocytes

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