This study reviewed the impact of endometriosis and its staging on assisted reproduction outcomes through a systematic review and meta-analysis. It found that while the presence of endometriosis did not affect clinical pregnancy or live birth rates, it was associated with a higher risk of miscarriage and fewer retrieved oocytes. More severe endometriosis (Stage III/IV) was also linked to fewer retrieved oocytes than less severe (Stage I/II) endometriosis.

1. UOG Journal Club: September 2014
Impact of endometriosis and its staging on assisted
reproduction outcome:
systematic review and meta-analysis
M.A.P. Barbosa, D. M. Teixeira, P.A.A.S. Navarro, R.A. Ferriani,
C. O. Nastri, W. P. Martins
Volume 44, Issue 3, Date: September 2014, Pages 261-278
Journal Club slides prepared by Ligita Jokubkiene
(UOG Editor for Trainees)

2. Impact of endometriosis and its staging on assisted reproduction outcome:
systematic review and meta-analysis
Barbosa et al., UOG 2014
• Does presence of endometriosis affect the outcome
of assisted reproductive techniques (ART)?
• Does severity of endometriosis affect the outcome
of ART?
Endometriosis affects:
• 6-10% of women of fertile age
• 35-50% women with subfertility, pelvic pain or both
Endometriosis treatment:
• Impact of medical/surgical treatment on fertility is
controversial

3. Impact of endometriosis and its staging on assisted reproduction outcome:
systematic review and meta-analysis
Barbosa et al., UOG 2014
Aim
To evaluate whether the presence or severity of
endometriosis affects the reproductive outcomes of
women undergoing assisted reproductive
techniques

4. Impact of endometriosis and its staging on assisted reproduction outcome:
systematic review and meta-analysis
Barbosa et al., UOG 2014
Inclusion criteria
• Any study with data on ART outcomes* in
women undergoing ART with and without a
previous diagnosis of endometriosis
• Studies comparing ART outcomes with
different stages of endometriosis
*Live birth, clinical pregnancy, miscarriage, number of oocytes retreived

5. Impact of endometriosis and its staging on assisted reproduction outcome:
systematic review and meta-analysis
Barbosa et al., UOG 2014
Data extracted from studies
• Study characteristics (design, aims, time period,
inclusion and exclusion criteria)
• Intervention and setting
• Ovulation induction protocol
• Severity of endometriosis
• Endometriosis treatment before ART

6. Impact of endometriosis and its staging on assisted reproduction outcome:
systematic review and meta-analysis
Barbosa et al., UOG 2014
Main outcomes
Primary outcome:
Live birth
Secondary outcome:
Clinical pregnancy
Additional outcomes:
• Miscarriage
• Number of oocytes retreived
Quality of evidence of studies analyzed by Newcastle-Ottawa scale
http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp

7. Impact of endometriosis and its staging on assisted reproduction outcome:
systematic review and meta-analysis
Effect of disease
20167 with endometriosis
compared with
121931 women without
endometriosis
Barbosa et al., UOG 2014
Effect of severity
1703 women with Stage III/IV
compared with
2227 women with Stage I/II
endometriosis

8. Impact of endometriosis and its staging on assisted reproduction outcome:
systematic review and meta-analysis
Barbosa et al., UOG 2014
Results: endometriosis vs control
Higher miscarriage risk for women with endometriosis
Lower number of retrieved oocytes in women with endometriosis

9. Impact of endometriosis and its staging on assisted reproduction outcome:
systematic review and meta-analysis
Barbosa et al., UOG 2014
Results: Stage I/II vs Stage III/IV risk comparison
Lower number of retreived oocytes in women with Stage III/IV
endometriosis vs Stage I/II

10. Impact of endometriosis and its staging on assisted reproduction outcome:
systematic review and meta-analysis
Barbosa et al., UOG 2014
Conclusions
Women undergoing ART have the same chance of
achieving clinical pregnancy and live birth
irrespective of the absence/presence or severity of
endometriosis

11. Impact of endometriosis and its staging on assisted reproduction outcome:
systematic review and meta-analysis
Barbosa et al., UOG 2014
Conclusions
Fewer oocytes are retrieved from women with
endometriosis vs no endometriosis
Fewer oocytes are retrieved from women with Stage
III/IV endometriosis vs Stage I/II
Possible higher risk for miscarriage in women with
endometriosis

12. Discussion points
• Should endometriosis be treated prior to commencing
ART treatment in order to improve pregnancy rate?
• Do women with endometriosis have lower chance of
live birth compared to women with other causes of
infertility?
• Do women with advanced stage endometriosis have
lower chances of live birth?
• What are the mechanisms that affect the chances of
achieving a live birth in women with endometriosis?
• What adverse ART outcomes are more likely in women
with endometriosis?