Ovarian endometriosis negatively impacts pregnancy outcomes in young infertile women undergoing IVF/ICSI treatment

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Abstract
This study aimed to investigate the effect of ovarian endometriosis (OE) on ovarian reserve, as well as on cumulative clinical pregnancy rates (cCPR) and cumulative live birth rates (cLBR) in groups of younger women (those under 35 years) and older women (those aged 35 years and above) who are experiencing infertility and receiving treatment through in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI). This retrospective analysis included a sample of 300 women diagnosed with OE and 2956 women without the condition, all of whom initiated their first IVF or ICSI cycle between January 2016 and December 2021. Participants were divided into two age categories: younger women (under 35 years) and older women (35 years and older). To establish a comparable baseline, a propensity score matching technique was utilized in a 1:1 ratio, considering age, body mass index, and duration of infertility to align women with OE against those without it. Both univariate and multivariate logistic regression analyses were applied to identify factors that influence cLBR. Furthermore, the ability of anti-Müllerian hormone (AMH) levels to predict cLBR was evaluated through receiver operating characteristic (ROC) curve analysis. Spearman's correlation was employed to examine the associations between age and AMH levels, as well as the relationship between cyst size and AMH levels. Women diagnosed with OE exhibited a significantly lower ovarian reserve, as indicated by reduced levels of AMH and a decreased antral follicle count, compared to those without the condition (P < 0.05). Within the younger age group, women with OE showed substantially lower cCPR and cLBR than their counterparts without OE (62.8% vs. 75.4%, P = 0.010; 56.1% vs. 67.6%, P = 0.025). In contrast, among older women, no significant differences in cCPR and cLBR were noted between those with OE and those without. Among younger women with OE, logistic regression analysis identified age, AMH levels, and the number of top-quality embryos as independent predictors of cLBR. ROC curve analysis determined an optimal AMH threshold of 1.835 ng/ml for predicting cLBR, with a sensitivity of 50.6% and specificity of 82.2%. AMH levels showed no correlation with age, but exhibited a negative correlation with cyst size. In contrast, among older women (≥ 35 years) with OE, AMH levels displayed a negative correlation with age but no significant association with cyst size. OE negatively impacts pregnancy outcomes in younger women, with AMH serving as an independent factor influencing cLBR.
Funding Information
  • National Key Research and Development Program of China (2022YFC2704000)

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