Endometriosis and Assisted Reproductive Technology United States Trends and Outcomes 2000 2011

Capsule:
Among assisted reproductive technology cycles, endometriosis, compared with male factor infertility, is associated with increased cycle cancellation, decreased hyperstimulation, and slightly lower but likely clinically comparable live-birth rates.

Authors:
Jennifer F. Kawwass, M.D., Sara Crawford, Ph.D., Donna R. Session, M.D., Dmitry M. Kissin, M.D., M.P.H., Denise J. Jamieson, M.D., M.P.H. for the National ART Surveillance System Group

Volume 103, Issue 6, Pages 1537-1543

Abstract:

Objective:
To assess endometriosis-associated infertility trends among assisted reproductive technology (ART) cycles, and to compare cancellation and hyperstimulation risks and pregnancy and live birth rates among women using ART for endometriosis-associated vs. male factor infertility.

Design:
Descriptive and multivariable analyses of Centers for Disease Control and Prevention (CDC) National ART Surveillance System data.

Setting:
Fertility centers.

Patient(s):
All reported fresh autologous ART cycles in the United States between 2000 and 2011 (n = 1,589,079).

Intervention(s):
None.

Main Outcome Measure(s):
Oocyte yield, hyperstimulation, cancellation, implantation, pregnancy, live birth.

Result(s):
The absolute number of ART cycles with an endometriosis diagnosis fell in recent years, from 16,751 (2000) to 15,311 (2011); the percentage fell over time, from 17.0% (2000) to 9.6% (2011) of all cycles. Compared with male factor (n = 375,557), endometriosis-associated cycles (n = 112,475) yielded fewer oocytes (50.5% vs. 42.5% of cycles with only 0–10 oocytes retrieved), lower risk of hyperstimulation (1.1% vs. 1.3%, adjusted risk ratio [aRR] 0.82, 95% confidence interval [CI] 0.74–0.91), and an increased risk of cancellation (12.9% vs. 10.1%, aRR 1.30, 95% CI 1.25–1.35). Endometriosis was associated with a statistically decreased but likely clinically insignificant difference in the following outcomes: chance of pregnancy per transfer (43.7% vs. 44.8%, aRR 0.96, 95% CI 0.95–0.98) among couples who did not also have tubal factor infertility and live birth per transfer (37.2% vs. 37.6%, aRR 0.96, 95% CI 0.94–0.98).

Conclusion(s):
The percentage of endometriosis-associated ART cycles has decreased over time. As compared with male factor infertility, endometriosis is associated with increased cancellation and decreased hyperstimulation risks. Despite decreased oocyte yield and higher medication dose, the difference in pregnancy and live birth rates may be of limited clinical significance, suggesting comparable pregnancy outcomes per transfer.

  • Jason M. Franasiak

    Although it can’t be proven, it seems likely that some of the decline in endometriosis diagnosis was due to decrease in LSC. That might suggest that the diagnoses that remain are due to ultrasound findings which may represent more advanced disease. Was there any thought to an analysis of outcomes vs. male factor over time? Perhaps those with endometriosis may do worse in later years attributable to more advanced disease diagnosed via ultrasound. A very nice manuscript, thank you!

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