The effects of surgery for endometriosis on pregnancy outcomes following in vitro fertilization and embryo transfer: a systematic review and meta-analysis

A Cristina Rossi, Federico Prefumo
Archives of gynecology and obstetrics · 2016 · vol. 294(3) , pp. 647–655 · doi:10.1007/s00404-016-4136-4 · PMID:27300002 · W2424792200
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⚙ AI-generated summary by claude@2026-06+body, 2026-06-07 ⓘ

Women with endometriosis undergoing IVF-ET had lower clinical pregnancy rates than controls, with worse outcomes in advanced stages, even after surgery.

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This systematic review and meta-analysis evaluated whether women with surgically confirmed endometriosis who underwent IVF-ET had different clinical pregnancy and delivery outcomes compared with controls without endometriosis, using studies published from 2000–2013 (13 studies; 980 with endometriosis and 5934 controls). Across all surgical management types, clinical pregnancy was lower in endometriosis (OR 0.65, 95% CI 0.44–0.96) while delivery rates were similar (OR 1.17, 95% CI 0.69–1.98); when surgery was operative, clinical pregnancy remained lower (OR 0.54), whereas diagnostic surgery did not show clear differences. Stage-dependent effects were reported, with mild (stage I–II) similar to controls for clinical pregnancy (OR 0.99) and more advanced (stage III–IV) lower (OR 0.45), and delivery not associated with stage. Limitations included reliance on observational data across heterogeneous included studies, and the finding that even after surgical removal, IVF-ET results remained worse than controls, indicating persistent confounding or residual disease effects. This paper is centrally about endometriosis — it synthesizes evidence on how endometriosis surgery affects IVF-ET pregnancy and delivery outcomes.

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Abstract

Purpose To review the literature about the effect of endometriosis on in vitro-fertilization and embryo-transfer (IVF-ET).

Methods

A search in EMBASE, MEDLINE, ClinicalTrial.gov, reference lists from 2000 to 2013 was conducted. Inclusion criteria were: endometriosis confirmed with histologic examination, women undergoing IVF-ET, endometriosis treated or diagnosed by surgery. Women undergoing IVF-ET after surgical removal of endometriosic implants, or a surgical diagnosis of endometriosis without its removal, were compared to women without endometriosis. Main outcomes were clinical pregnancy and delivery rates.

Results

Thirteen studies were selected, including 980 women with endometriosis and 5934 controls. Clinical pregnancy rate was lower in women with endometriosis than in controls (OR 0.65; 95 % CI 0.44–0.96), but delivery rate was similar (OR 1.17; 95 % CI 0.69–1.98). When surgery was operative, clinical pregnancy rate after IVF-ET was lower in endometriosis than controls (OR 0.54; 95 % CI 0.34–0.85), but delivery rate was similar (OR 1.12; 95 % CI 0.60–2.07). When surgery was diagnostic, clinical pregnancy (OR 1.15; 95 % CI 0.46–2.84) and delivery rates (OR 1.65; 95 % CI 0.36–7.45) did not differ between the groups. Site of endometriosis was not related to IVF-ET outcomes. Clinical pregnancy rates were similar between stage I-II and controls (OR 0.99; 95 % CI 0.63–1.56) but lower in stage III-IV than controls (OR 0.45; 95 % CI 0.29–0.70), whereas delivery rate was not associated with stage.

Conclusions

In the presence of endometriosis, the clinical pregnancy rate after IVF-ET is lower than in controls. The prognosis is better for mild endometriosis compared with more advanced stages. Even after surgical removal of endometriosis, IVF-ET results remain worse than in controls. Similar content being viewed by others

References

Vercellini P, Barbara G, Buggio L, Frattaruolo MP, Somigliana E, Fedele L (2012) Effect of patient selection on estimate of reproductive success after surgery for rectovaginal endometriosis: literature review. Reprod Biomed Online 24:389–395 Stepniewska A, Pomini P, Bruni F, Mereu L, Ruffo G, Ceccaroni M, Scioscia M, Guerriero M, Minelli L (2009) Laparoscopic treatment of bowel endometriosis in infertile women. Hum Reprod 24:1619–1625 Mahutte NG, Arici A (2002) New advances in the understanding of endometriosis related infertility. J Reprod Immunol 55:73–83 Marcoux S, Maheux R, Berube S (1997) Laparoscopic surgery in infertile women with minimal or mild endometriosis. Canadian Collaborative Group on Endometriosis. N Engl J Med 337:217–222 Panidis DK, Matalliotakis IM (1998) Subfertility associated with minimal to mild endometriosis. Main mechanisms. J Reprod Med 43:1034–1042 Barnhart K, Dunsmoor-Su R, Coutifaris C (2002) Effect of endometriosis on in vitro fertilization. Fertil Steril 77:1148–1155 Mahadevan MM, Trounson AO, Leeton JF (1983) The relationship of tubal blockage, infertility of unknown cause, suspected male infertility, and endometriosis to success of in vitro fertilization and embryo transfer. Fertil Steril 40:755–762 Yanushpolsky EH, Best CL, Jackson KV, Clarke RN, Barbieri RL, Hornstein MD (1998) Effects of endometriomas on oocyte quality, embryo quality, and pregnancy rates in in vitro fertilization cycles: a prospective, case-controlled study. J Assist Reprod Genet 15:193–197 Revised American Fertility Society classification of endometriosis (1985) 1985. Fertil Steril 43:351–352 Aboulghar MA, Mansour RT, Serour GI, Al-Inany HG, Aboulghar MM (2003) The outcome of in vitro fertilization in advanced endometriosis with previous surgery: a case-controlled study. Am J Obstet Gynecol 188:371–375 Al-Fadhli R, Kelly SM, Tulandi T, Tanr SL (2006) Effects of different stages of endometriosis on the outcome of in vitro fertilization. J Obstet Gynaecol Can 28:888–891 Bukulmez O, Yarali H, Gurgan T (2001) The presence and extent of endometriosis do not effect clinical pregnancy and implantation rates in patients undergoing intracytoplasmic sperm injection. Eur J Obstet Gynecol Reprod Biol 96:102–107 Cirpan T, Akercan F, Tavmergen Goker EN, Ozyurek E, Levi R, Tavmergen E (2007) Laparoscopic resection or sonography-guided vaginal aspiration of endometriomas prior to ICSI-ET does not worsen treatment outcomes. Clin Exp Obstet Gynecol 34:215–218 Coccia ME, Rizzello F, Mariani G, Bulletti C, Palagiano A, Scarselli G (2011) Impact of endometriosis on in vitro fertilization and embryo transfer cycles in young women: a stage-dependent interference. Acta Obstet Gynecol Scand 90:1232–1238 Dong X, Liao X, Wang R, Zhang H (2013) The impact of endometriosis on IVF/ICSI outcomes. Int J Clin Exp Pathol 6:1911–1918 Kuivasaari P, Hippelainen M, Anttila M, Heinonen S (2005) Effect of endometriosis on IVF/ICSI outcome: stage III/IV endometriosis worsens cumulative pregnancy and live-born rates. Hum Reprod 20:3130–3135 Lin XN, Wei ML, Tong XM, Xu WH, Zhou F, Huang QX, Wen GF, Zhang SY (2012) Outcome of in vitro fertilization in endometriosis-associated infertility: a 5-year database cohort study. Chin Med J (Engl) 125:2688–2693 Loo TC, Lin MY, Chen SH, Chung MT, Tang HH, Lin LY, Tsai YC (2005) Endometrioma undergoing laparoscopic ovarian cystectomy: its influence on the outcome of in vitro fertilization and embryo transfer (IVF-ET). J Assist Reprod Genet 22:329–333 Marconi G, Vilela M, Quintana R, Sueldo C (2002) Laparoscopic ovarian cystectomy of endometriomas does not affect the ovarian response to gonadotropin stimulation. Fertil Steril 78:876–878 Matalliotakis IM, Cakmak H, Mahutte N, Fragouli Y, Arici A, Sakkas D (2007) Women with advanced-stage endometriosis and previous surgery respond less well to gonadotropin stimulation, but have similar IVF implantation and delivery rates compared with women with tubal factor infertility. Fertil Steril 88:1568–1572 Omland AK, Fedorcsak P, Storeng R, Dale PO, Abyholm T, Tanbo T (2001) Natural cycle IVF in unexplained, endometriosis-associated and tubal factor infertility. Hum Reprod 16:2587–2592 Somigliana E, Arnoldi M, Benaglia L, Iemmello R, Nicolosi AE, Ragni G (2008) IVF-ICSI outcome in women operated on for bilateral endometriomas. Hum Reprod 23:1526–1530 Nisolle M, Donnez J (1997) Peritoneal endometriosis, ovarian endometriosis, and adenomyotic nodules of the rectovaginal septum are three different entities. Fertil Steril 68:585–596 Pal L, Shifren JL, Isaacson KB, Chang Y, Leykin L, Toth TL (1998) Impact of varying stages of endometriosis on the outcome of in vitro fertilization-embryo transfer. J Assist Reprod Genet 15:27–31 Tinkanen H, Kujansuu E (2000) In vitro fertilization in patients with ovarian endometriomas. Acta Obstet Gynecol Scand 79:119–122 Bedaiwy MA, Falcone T, Katz E, Goldberg JM, Assad R, Thornton J (2008) Association between time from endometriosis surgery and outcome of in vitro fertilization cycles. J Reprod Med 53:161–165 Author information Authors and Affiliations Corresponding author Ethics declarations Conflict of interest We have no conflict of interest to declare. Ethical approval This article does not contain any studies with human participants performed by any of the authors. Rights and permissions About this article Cite this article Rossi, A.C., Prefumo, F. The effects of surgery for endometriosis on pregnancy outcomes following in vitro fertilization and embryo transfer: a systematic review and meta-analysis. Arch Gynecol Obstet 294, 647–655 (2016). https://doi.org/10.1007/s00404-016-4136-4 Received: Accepted: Published: Issue date: DOI: https://doi.org/10.1007/s00404-016-4136-4

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Condition tags

mesh:D004715endometriosis

MeSH descriptors

Embryo Transfer Endometriosis Fertilization in Vitro Endometriosis Female Humans Infertility, Female Infertility, Female Pregnancy Pregnancy Outcome Pregnancy Rate

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