title: The effect of endometriosis on implantation: results from the Yale University in vitro fertilization and embryo transfer program.
abstract: OBJECTIVE
  To investigate the effect of endometriosis on implantation.
  
  
  METHODS
  Case-control study from Yale University IVF-ET program.
  
  
  METHODS
  Two hundred eighty-four consecutive IVF cycles were analyzed retrospectively. Patients with endometriosis only (n = 35; 89 cycles) were compared with an age-matched control group with tubal infertility (n = 70; 147 cycles) and also to a group with unexplained infertility (n = 15; 48 cycles). Data from the endometriosis group was analyzed further in subgroups of minimal-mild (43 cycles) and moderate-severe (46 cycles).
  
  
  RESULTS
  No difference was found in the number and the quality of oocytes retrieved and fertilization rates between the endometriosis, the tubal infertility, and the unexplained infertility groups. The quality and the number of embryos transferred in each group were comparable. A trend toward reduced pregnancy rate per transfer (14.8%) in the endometriosis versus tubal or unexplained infertility groups (25.7% and 23.3%, respectively) was observed. Implantation rate (gestational sac per transferred embryo) was significantly lower in the endometriosis versus the tubal infertility group (3.9% versus 8.1%; unexplained infertility group, 7.2%). Analysis of first cycles only across all groups revealed that the implantation rate also was significantly lower in the endometriosis versus the tubal infertility group (3.1% versus 9%; unexplained infertility group, 6.7%). Within the endometriosis group, although the pregnancy rate per cycle and per transfer were similar in subgroups, patients with minimal-mild endometriosis had the lowest implantation rate.
  
  
  CONCLUSIONS
  We conclude that, in patients with endometriosis, implantation rate is low. Abnormal implantation, which may be secondary to endometrial dysfunction or embryotoxic environment, is a factor in endometriosis-associated subfertility.
authors.affiliation: Department of Obstetrics and Gynecology, Yale University School of Medicine, New Haven, Connecticut 06510, USA.
authors.forename: A
authors.initials: A
authors.lastname: Arici
authors.forename: E
authors.initials: E
authors.lastname: Oral
authors.forename: O
authors.initials: O
authors.lastname: Bukulmez
authors.forename: A
authors.initials: A
authors.lastname: Duleba
authors.forename: D L
authors.initials: DL
authors.lastname: Olive
authors.forename: E E
authors.initials: EE
authors.lastname: Jones
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D010064:Embryo Implantation; D004624:Embryo Transfer; D004715:Endometriosis / Q000503:physiopathology*; D005184:Fallopian Tube Diseases / Q000150:complications; D005260:Female; D005307:Fertilization in Vitro; D006801:Humans; D007247:Infertility, Female / Q000209:etiology / Q000503:physiopathology; D011247:Pregnancy; D018873:Pregnancy Rate; D012189:Retrospective Studies