title: Endometriosis and assisted reproductive technology: United States trends and outcomes 2000-2011.
abstract: OBJECTIVE
  To assess endometriosis-associated infertility trends among assisted reproductive technology (ART) cycles, and to compare cancellation and hyperstimulation risks and pregnancy and live birth rates among women using ART for endometriosis-associated vs. male factor infertility.
  
  
  METHODS
  Descriptive and multivariable analyses of Centers for Disease Control and Prevention (CDC) National ART Surveillance System data.
  
  
  METHODS
  Fertility centers.
  
  
  METHODS
  All reported fresh autologous ART cycles in the United States between 2000 and 2011 (n = 1,589,079).
  
  
  METHODS
  None.
  
  
  METHODS
  Oocyte yield, hyperstimulation, cancellation, implantation, pregnancy, live birth.
  
  
  RESULTS
  The absolute number of ART cycles with an endometriosis diagnosis fell in recent years, from 16,751 (2000) to 15,311 (2011); the percentage fell over time, from 17.0% (2000) to 9.6% (2011) of all cycles. Compared with male factor (n = 375,557), endometriosis-associated cycles (n = 112,475) yielded fewer oocytes (50.5% vs. 42.5% of cycles with only 0-10 oocytes retrieved), lower risk of hyperstimulation (1.1% vs. 1.3%, adjusted risk ratio [aRR] 0.82, 95% confidence interval [CI] 0.74-0.91), and an increased risk of cancellation (12.9% vs. 10.1%, aRR 1.30, 95% CI 1.25-1.35). Endometriosis was associated with a statistically decreased but likely clinically insignificant difference in the following outcomes: chance of pregnancy per transfer (43.7% vs. 44.8%, aRR 0.96, 95% CI 0.95-0.98) among couples who did not also have tubal factor infertility and live birth per transfer (37.2% vs. 37.6%, aRR 0.96, 95% CI 0.94-0.98).
  
  
  CONCLUSIONS
  The percentage of endometriosis-associated ART cycles has decreased over time. As compared with male factor infertility, endometriosis is associated with increased cancellation and decreased hyperstimulation risks. Despite decreased oocyte yield and higher medication dose, the difference in pregnancy and live birth rates may be of limited clinical significance, suggesting comparable pregnancy outcomes per transfer.
authors.affiliation: Division of Reproductive Endocrinology and Infertility, Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia; Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia. Electronic address: jennifer.kawwass@emory.edu.
authors.forename: Jennifer F
authors.initials: JF
authors.lastname: Kawwass
authors.affiliation: Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Sara
authors.initials: S
authors.lastname: Crawford
authors.affiliation: Division of Reproductive Endocrinology and Infertility, Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Donna R
authors.initials: DR
authors.lastname: Session
authors.affiliation: Division of Reproductive Endocrinology and Infertility, Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia; Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Dmitry M
authors.initials: DM
authors.lastname: Kissin
authors.affiliation: Division of Reproductive Endocrinology and Infertility, Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia; Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Denise J
authors.initials: DJ
authors.lastname: Jamieson
mesh_terms: D000328:Adult; D017677:Age Distribution; D015984:Causality; D015897:Comorbidity; D004715:Endometriosis / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D006801:Humans; D007247:Infertility, Female / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D007248:Infertility, Male / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D050498:Live Birth / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D011247:Pregnancy; D027724:Reproductive Techniques, Assisted / Q000639:trends*; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: ART; Endometriosis; cancellation; hyperstimulation; outcomes