title: Prognostic factors for assisted reproductive technology in women with endometriosis-related infertility.
abstract: BACKGROUND
  Assisted reproductive technology is one of the therapeutic options offered for managing endometriosis-associated infertility. Yet, published data on assisted reproductive technology outcome in women affected by endometriosis are conflicting and the determinant factors for pregnancy chances unclear.
  
  
  OBJECTIVE
  We sought to evaluate assisted reproductive technology outcomes in a series of 359 endometriosis patients, to identify prognostic factors and determine if there is an impact of the endometriosis phenotype.
  
  
  METHODS
  This was a retrospective observational cohort study, including 359 consecutive endometriosis patients undergoing in vitro fertilization or intracytoplasmic sperm injection, from June 2005 through February 2013 at a university hospital. Endometriotic lesions were classified into 3 phenotypes-superficial peritoneal endometriosis, endometrioma, or deep infiltrating endometriosis-based on imaging criteria (transvaginal ultrasound, magnetic resonance imaging); histological proof confirmed the diagnosis in women with a history of surgery for endometriosis. Main outcome measures were clinical pregnancy rates and live birth rates per cycle and per embryo transfer. Prognostic factors of assisted reproductive technology outcome were identified by comparing women who became pregnant and those who did not, using univariate and adjusted multiple logistic regression models.
  
  
  RESULTS
  In all, 359 endometriosis patients underwent 720 assisted reproductive technology cycles. In all, 158 (44%) patients became pregnant, and 114 (31.8%) had a live birth. The clinical pregnancy rate and the live birth rate per embryo transfer were 36.4% and 22.8%, respectively. The endometriosis phenotype (superficial endometriosis, endometrioma, or deep infiltrating endometriosis) had no impact on assisted reproductive technology outcomes. After multivariate analysis, history of surgery for endometriosis (odds ratio, 0.14; 95% confidence ratio, 0.06-0.38) or past surgery for endometrioma (odds ratio, 0.39; 95% confidence ratio, 0.18-0.84) were independent factors associated with lower pregnancy rates. Anti-müllerian hormone levels <2 ng/mL (odds ratio, 0.51; 95% confidence ratio, 0.28-0.91) and antral follicle count <10 (odds ratio, 0.27; 95% confidence ratio, 0.14-0.53) were also associated with negative assisted reproductive technology outcomes.
  
  
  CONCLUSIONS
  The endometriosis phenotype seems to have no impact on assisted reproductive technology results. An altered ovarian reserve and a previous surgery for endometriosis and/or endometrioma are associated with decreased pregnancy rates.
authors.affiliation: Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Assistance Publique-Hôpitaux de Paris, Hôpital Universitaire Paris Centre, Centre Hospitalier Universitaire Cochin, Department of Gynaecology Obstetrics II and Reproductive Medicine, Paris, France.
authors.forename: Chloé
authors.initials: C
authors.lastname: Maignien
authors.affiliation: Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Assistance Publique-Hôpitaux de Paris, Hôpital Universitaire Paris Centre, Centre Hospitalier Universitaire Cochin, Department of Gynaecology Obstetrics II and Reproductive Medicine, Paris, France; Institut Cochin, Institut National de la Santé et de la Recherche Médicale U1016, Laboratoire d'Immunologie and Département de Génetique, Développement et Cancer, Université Paris Descartes, Sorbonne Paris Cité, Paris, France. Electronic address: pietro.santulli@cch.aphp.fr.
authors.forename: Pietro
authors.initials: P
authors.lastname: Santulli
authors.affiliation: Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Assistance Publique-Hôpitaux de Paris, Hôpital Universitaire Paris Centre, Centre Hospitalier Universitaire Cochin, Department of Gynaecology Obstetrics II and Reproductive Medicine, Paris, France.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Gayet
authors.affiliation: Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Assistance Publique-Hôpitaux de Paris, Hôpital Universitaire Paris Centre, Centre Hospitalier Universitaire Cochin, Department of Gynaecology Obstetrics II and Reproductive Medicine, Paris, France.
authors.forename: Marie-Christine
authors.initials: MC
authors.lastname: Lafay-Pillet
authors.affiliation: Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Assistance Publique-Hôpitaux de Paris, Hôpital Universitaire Paris Centre, Centre Hospitalier Universitaire Cochin, Department of Gynaecology Obstetrics II and Reproductive Medicine, Paris, France.
authors.forename: Diane
authors.initials: D
authors.lastname: Korb
authors.affiliation: Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Assistance Publique-Hôpitaux de Paris, Hôpital Universitaire Paris Centre, Centre Hospitalier Universitaire Cochin, Department of Gynaecology Obstetrics II and Reproductive Medicine, Paris, France.
authors.forename: Mathilde
authors.initials: M
authors.lastname: Bourdon
authors.affiliation: Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Assistance Publique-Hôpitaux de Paris, Hôpital Universitaire Paris Centre, Centre Hospitalier Universitaire Cochin, Department of Gynaecology Obstetrics II and Reproductive Medicine, Paris, France; Institut Cochin, Institut National de la Santé et de la Recherche Médicale U1016, Laboratoire d'Immunologie and Département de Génetique, Développement et Cancer, Université Paris Descartes, Sorbonne Paris Cité, Paris, France.
authors.forename: Louis
authors.initials: L
authors.lastname: Marcellin
authors.affiliation: Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Assistance Publique-Hôpitaux de Paris, Hôpital Universitaire Paris Centre, Centre Hospitalier Universitaire Cochin, Department of Gynaecology Obstetrics II and Reproductive Medicine, Paris, France.
authors.forename: Dominique
authors.initials: D
authors.lastname: de Ziegler
authors.affiliation: Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Assistance Publique-Hôpitaux de Paris, Hôpital Universitaire Paris Centre, Centre Hospitalier Universitaire Cochin, Department of Gynaecology Obstetrics II and Reproductive Medicine, Paris, France; Institut Cochin, Institut National de la Santé et de la Recherche Médicale U1016, Laboratoire d'Immunologie and Département de Génetique, Développement et Cancer, Université Paris Descartes, Sorbonne Paris Cité, Paris, France.
authors.forename: Charles
authors.initials: C
authors.lastname: Chapron
mesh_terms: D000328:Adult; D015331:Cohort Studies; D004715:Endometriosis / Q000150:complications* / Q000235:genetics; D005260:Female; D006801:Humans; D007247:Infertility, Female / Q000209:etiology*; D050498:Live Birth; D010532:Peritoneal Diseases / Q000150:complications* / Q000235:genetics; D010641:Phenotype; D011247:Pregnancy; D018873:Pregnancy Rate; D011379:Prognosis; D027724:Reproductive Techniques, Assisted; D012189:Retrospective Studies
keywords: assisted reproductive technologies; endometriosis phenotypes; ovarian reserve; pregnancy; surgery