title: Influence of endometriosis on assisted reproductive technology outcomes: a systematic review and meta-analysis.
abstract: OBJECTIVE
  To investigate the association of endometriosis on assisted reproductive technology (ART) outcomes and to review if surgical treatment of endometriosis before ART affects the outcomes.
  
  
  METHODS
  We searched studies published between 1980 and 2014 on endometriosis and ART outcome. We searched MEDLINE, PubMed, ClinicalTrials.gov, and Cochrane databases and performed a manual search.
  
  
  METHODS
  A total of 1,346 articles were identified, and 36 studies were eligible to be included for data synthesis. We included published cohort studies and randomized controlled trials.
  
  
  RESULTS
  Compared with women without endometriosis, women with endometriosis undertaking in vitro fertilization and intracytoplasmic sperm injection have a similar live birth rate per woman (odds ratio [OR] 0.94, 95% confidence interval [CI] 0.84-1.06, 13 studies, 12,682 patients, I=35%), a lower clinical pregnancy rate per woman (OR 0.78, 95% CI 0.65-0.94), 24 studies, 20,757 patients, I=66%), a lower mean number of oocyte retrieved per cycle (mean difference -1.98, 95% CI -2.87 to -1.09, 17 studies, 17,593 cycles, I=97%), and a similar miscarriage rate per woman (OR 1.26, 95% CI (0.92-1.70, nine studies, 1,259 patients, I=0%). Women with more severe disease (American Society for Reproductive Medicine III-IV) have a lower live birth rate, clinical pregnancy rate, and mean number of oocytes retrieved when compared with women with no endometriosis.
  
  
  CONCLUSIONS
  Women with and without endometriosis have comparable ART outcomes in terms of live births, whereas those with severe endometriosis have inferior outcomes. There is insufficient evidence to recommend surgery routinely before undergoing ART.
authors.affiliation: Human Development and Health Unit, University of Southampton, Faculty of Medicine, and Complete Fertility Centre Southampton, Princess Anne Hospital, Southampton, United Kingdom; and the Departments of Obstetrics and Gynaecology, University of Malaya, Faculty of Medicine, Kuala Lumpur, Malaysia, and Maastricht University Medical Centre, Maastricht, The Netherlands.
authors.forename: Mukhri
authors.initials: M
authors.lastname: Hamdan
authors.forename: Siti Z
authors.initials: SZ
authors.lastname: Omar
authors.forename: Gerard
authors.initials: G
authors.lastname: Dunselman
authors.forename: Ying
authors.initials: Y
authors.lastname: Cheong
mesh_terms: D000022:Abortion, Spontaneous / Q000453:epidemiology; D001723:Birth Rate; D015331:Cohort Studies; D004715:Endometriosis / Q000453:epidemiology* / Q000601:surgery*; D005260:Female; D005307:Fertilization in Vitro; D006801:Humans; D050498:Live Birth; D054315:Oocyte Retrieval; D011247:Pregnancy; D016032:Randomized Controlled Trials as Topic; D027724:Reproductive Techniques, Assisted; D012720:Severity of Illness Index