The effect of endometriosis on implantation in women with endometriosis associated infertility

Women with recurrent endometriomas have adverse in vitro fertilization outcomes due to the implantation failure.

Key Points

Highlights:

• Although the presence of recurrent endometriomas does not alter the number of embryos and the number of high-quality embryos in women with infertility compared to women with other etiologies for infertility, the implantation rate per cycle is significantly decreased in these women.

 Importance:

• Future research should be performed to clarify decreased implantation rate in women with endometriosis-associated infertility despite having similar embryo quality with other infertile women.

What’s done here?

• Women aged between 26 and 40 years and planned to get pregnant via in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) methods were included.
• The study population was divided into two groups: group I included 70 women with recurrent unilateral endometriomas and group II included 50 women with tubal factor infertility.
• The gonadotropin dosage was assessed depending on the age, serum AMH measured on the second day of the menstrual cycle and ultrasonographic characteristics of the ovaries.
• After embryo transfer which was performed using a high-quality embryo, the implantation rate was compared between groups.

 Key results:

• The serum anti-Müllerian level, as one of the most reliable markers of ovarian reserve, was significantly lower in Group I.
• Women in Group I had significantly longer gonadotropin stimulation duration compared to women in Group II.
• The number of retrieved embryos and the number of high-quality embryos were comparable between groups.
• However, the implantation rate was significantly lower in Group I, especially in women having endometriomas larger than 3 cm.

Lay Summary

One of the most common clinical findings of women with endometriosis is fertility problems.

Women with endometriosis often benefit from in vitro fertilization methods to get pregnant. However, whether there is a detrimental effect of endometriosis on in vitro fertilization outcomes is a controversial issue.

Yevseyevich et al, a group of scientists from the Russian Federation, at the RUDN University, center of reproduction and genetics NOVA CLINIC,  published a study titled “Implantation failures in women with infertility associated endometriosis” in the journal named Gynecological Endocrinology.

The authors sought to evaluate the quality of embryos and implantation rate in women with endometriosis-associated infertility by comparing them with women having tubal factor infertility. The women were similar depending on their age and infertility duration. 

The duration of gonadotropin stimulation was longer in women with endometriosis. Although the number of retrieved embryos and the number of high-quality embryos were comparable between groups, the implantation rate was significantly lower in the patients with endometriosis, especially in women having endometriomas larger than 3 cm.

Thus, the authors emphasized the role of endometrial receptivity and the interaction between the embryo and the endometrium for decreased implantation rate in women with endometriosis-associated infertility.

“The ambiguity of theories concerning the occurrence of endometriosis-associated infertility prompts the researchers to further investigation of potential mechanisms of endometriosis.” the authors added.

Research Source: https://www.ncbi.nlm.nih.gov/pubmed/31532313