Increased obstetrical complications after ART therapy in endometriosis patients.

The presence of endometriosis and adenomyosis reduce the success rate of ART therapy more than normal cases.

Key Points

Importance:

• For women diagnosed as adenomyosis who planned to conceive using ART therapy, a higher risk of maternal and fetal complications are expected due to irregular blood flow of myometrium and placenta.

Highlights:

• The presence of ectopic endometrium is the characteristic of both endometriosis and adenomyosis to cause obstetrical complications either spontaneous or ART applied pregnancies.

 What's done here:

• To evaluate their adverse obstetric outcomes, the authors analyzed the patients with endometriosis and adenomyosis who had received ART therapies for their infertility complaints and compared their results with healthy pregnancies.

Key results:

• Regardless of conceiving whether it was spontaneous or by ART therapy, the women with endometriosis and adenomyosis have an increased risk of obstetrical complications.
• The types of obstetrical complications in women diagnosed as adenomyosis differ from women diagnosed as endometriosis. High risked maternal and fetal complications like preterm delivery, preeclampsia, placenta previa, and ablatio placenta are seen mostly in women with adenomyosis.
• Comparing endometriotic patients to normal cases placenta previa occurred more frequent and can be explained by progesterone resistance and inadequate uterine contractibility which cause deferred implantation.
• The reason that the placenta carried by adenomyotic or endometriotic uterus has diminished blood flow, the placental hypoperfusion may lead the FGR and placental ablatio. 

Limitations:

• Diagnosis of endometriosis and adenomyosis in this report have no pathologic shreds of evidence, authors accepted them as correct according to the patient's questionnaire forms.

Lay Summary

To examine the impact of endometriosis and adenomyosis on ART therapy, Harada et al. from the Department of Obstetrics and Gynecology of Tottori University, Japan, planned a prospective cohort study and published their results recently in PLoS One. 

The study pool consists of 103.099 pregnancies that resulted in live-birth, stillbirth or abortion between February 2011 and July 2014 on 15 different regions of Japan. The presence of adenomyosis or endometriosis in these patients was based on the responses to a self-reported questionnaire and in the end, the numbers of women who declared their endometriosis and adenomyosis were 3517 and 325 respectively.

For the assessment of the results, the authors used statistical significance tests.  

After ART therapies, the frequency of obstetric complications in endometriotic and adenomyotic patients founded  53.6% and 60% respectively. Higher incidence rates were obtained in endometriosis and adenomyosis groups than in healthy women groups regarding obstetric complications such as gestational diabetes, preterm premature rupture of membranes and placenta previa.

Only the group of women with a medical history of adenomyosis experienced adverse effects of mild preeclampsia, placental abruption, fetal growth retardation, and fetal death when compared to women without adenomyosis.

The obstetric complication rates like preterm births, preterm premature rupture of membranes and placenta previa were also statistically significant between spontaneous conception patients with endometriosis and ART-treated group. 

The authors claimed that this study is the first report that indicates the negative impacts of adenomyosis and endometriosis on the progression of pregnancies especially after adjusting for the confounding influence of ART.

Research Source: https://www.ncbi.nlm.nih.gov/pubmed/?term=31374085