Should I Have Endometriosis Surgery Before IVF-ICSI?

The pros and cons of endometriosis surgery before assisted reproduction should be carefully weighed, study says.

Key Points

Highlights: 

• The live birth rate per assisted reproduction technology cycle is significantly lower among women who underwent endometriosis surgery before the procedure.

Importance:

• All pros and cons should carefully be weighed when referring infertile endometriosis patients to surgery or assisted reproduction.

What’s done here:

• Researchers conducted a literature review and meta-analysis of 19 studies to compare the ongoing pregnancy and live birth rates between women who underwent endometriosis surgery before the procedure and those who did not. 

Key results:

• There were no significant differences in live birth, ongoing pregnancy, and early pregnancy loss rates per cycle between women who underwent endometriosis surgery before IVF/ICSI and those who did not.
• When the study with a high risk of bias was excluded, the live birth rates were significantly low in women who underwent endometriosis surgery before IVF/ICSI.

Limitations:

• Observational studies were included in the meta-analysis so there may result in comparison bias between the groups.
• No data was available about the presence of endometriomas or the type of previous endometriosis surgery.
• There was a high degree of heterogeneity between the studies included in the meta-analysis. 

Lay Summary

The live birth rate per in vitro fertilization (IVF) or intrauterine sperm injection (ICSI) cycle was significantly reduced in women who underwent surgery to treat endometriosis before the procedures, found a new study published in the scientific journal Reproductive Sciences. 

“These data urge the clinician to carefully weigh the pros and cons before referring infertile patients with endometriosis to surgery before IVF,” the authors of the study said, “highlighting the key role of multidisciplinary referral centers”.

To clarify the long-standing issue of whether undergoing endometriosis before assisted reproduction such as IVF or ICSI may be beneficial in terms of reproductive outcomes, a team of researchers led by Dr. Pietro Santulli from Paris, France conducted a systematic review and meta-analysis of the literature to compare ongoing pregnancy and live birth rates in women who underwent endometriosis surgery before IVF or ICSI and women who did not.

The team identified and analyzed 19 studies. They found no statistically significant differences in terms of live birth rates, ongoing pregnancy rates, and early pregnancy loss rates per cycle between women who had endometriosis surgery before assisted reproduction and those who did not. 

However, when they excluded the studies that had a high risk of bias, they found that the live birth rate per cycle was significantly lower among women who underwent endometriosis surgery before assisted reproduction compared to those who did not.

“To conclude, endometriosis surgery before IVF should not be recommended to improve ART results, given that no significant benefit has been highlighted,” the researchers wrote. “Yet, surgery might be considered in specific clinical situations, such as uncontrolled pain symptoms, or repeated IVF implantation failure”. 

Research Source: https://pubmed.ncbi.nlm.nih.gov/38168857/