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Abstract
To investigate the IVF outcome for patients with endometriosis.
Meta-analysis.
Academic research center.
A MEDLINE search and review of the literature were performed. Patients were classified
by level of endometriosis, and controls were classified according to the indication
for IVF.
Bivariate analysis and multivariate logistic regression was used to estimate overall
effect and control for confounding.
Pregnancy rates, fertilization rate, implantation rates, and numbers of oocytes retrieved.
Twenty-two published studies were included in the overall analysis. The chance of
achieving pregnancy was significantly lower for endometriosis patients (odds ratio,
0.56; 95% confidence interval, 0.44-0.70) when compared with tubal factor controls.
Multivariate analysis also demonstrated a decrease in fertilization and implantation
rates, and a significant decrease in the number of oocytes retrieved for endometriosis
patients. Pregnancy rates for women with severe endometriosis were significantly lower
than for women with mild disease (odds ratio, 0.60; 95% confidence interval, 0.42-0.87).
Patients with endometriosis-associated infertility undergoing IVF respond with significantly
decreased levels of all markers of reproductive process, resulting in a pregnancy
rate that is almost one half that of women with other indications for IVF. These data
suggest that the effect of endometriosis is not exclusively on the receptivity of
the endometrium but also on the development of the oocyte and embryo.