Does The Severity of Endometriosis Pain Affect the Chance of Having a Baby With IVF?

The severity of pain does not affect the outcome of assisted reproduction in women with endometriosis

Key Points

Highlights: 

• The severity of endometriosis pain has no effect on the live birth rate following assisted reproduction.

Importance:

• This finding suggests that several factors should be taken into account when choosing between using assisted reproduction or undergoing surgery.

What’s done here:

• Researchers used univariable and multivariate analysis to assess the effect of endometriosis-associated pain on the live birth rate following assisted reproduction.

Key results:

• There was no significant difference in pain intensity between patients who had a live birth and patients who did not, following assisted reproduction.
• There was no significant difference in the proportion of patients experiencing severe pain who did have a live birth or not following assisted reproduction.

Limitations:

• Endometrosis was diagnosed using imaging techniques and not surgery the gold standard for the diagnosis of the disease.

Lay Summary

Severe pain symptoms in endometriosis have no relation with the outcomes of assisted reproductive techniques such as in vitro fertilization (IVF), according to a new study published in the journal Human Reproduction. 

This finding suggests that the decision-making process for deciding between assisted reproduction and surgery in women with endometriosis who are infertile should be based on a “multitude of aspects”  instead of just focusing on a single point such as pain, according to the authors. These aspects should include the choice of the patient, other factors that may affect fertility, other symptoms of endometriosis, and the efficacy of medical therapies in managing the pain. The authors added that the approach should be individualized and guided by a multidisciplinary team of experts.

To explore whether severe pain due to endometriosis affects the live birth rate following assisted reproduction, a team of researchers led by Dr. Piettro Santulli from Faculté de Santé, Université de Paris in Paris, France conducted an observational cohort study from October 2014 to October 2021 in 354 patients with endometriosis who used assisted reproduction techniques to conceive. Of these 354 women, 127 had undergone previous endometriosis surgery.

The researchers used a 10-point visual analog scale to assess the intensity of the pain that the women were experiencing before assisted reproduction. This included painful periods, pain during intercourse, chronic pelvic pain, gastrointestinal pain, or lower urinary tract pain. The pain was considered severe if the women scored seven or higher for at least one type of pain.  

The main objective was the cumulative live birth rate per patient.

The results showed that most patients (68.4%) had severe pain symptoms, and the cumulative live birth rate per patient was 63.8%. There was no significant difference in mean visual analog scale scores for different types of pain between patients who had a live birth and patients who did not. There was also no significant difference in the proportion of patients experiencing severe pain. 

The researchers said the only significant factors associated with negative live births were age above 35 and anti-Müllerian hormone levels below 1.2 ng/mL.

“Severe pain symptoms are not associated with reduced [assisted reproductive technology] live birth rates in endometriosis patients,” they concluded.

Research Source: https://pubmed.ncbi.nlm.nih.gov/38142239/