IMPACT OF ENDOMETRIOSIS ON REPRODUCTIVE OUTCOMES IN WOMEN UNDERGOING ASSISTED REPRODUCTIVE TECHNIQUES

Abstract

DOI: https://doi.org/10.46296/yc.v10i19.0987

Abstract

Introduction: Endometriosis is associated with infertility and can alter ovarian reserve, response to stimulation, oocyte competence, embryonic development, and endometrial receptivity. However, its impact on clinical outcomes of assisted reproductive technologies (ART) remains controversial. Objective: To synthesize full-text evidence available up to April 30, 2026, regarding the impact of endometriosis on ovarian, embryonic, and clinical outcomes in women undergoing in vitro fertilization (IVF), intracytoplasmic sperm injection (ICSI), and fresh or cryopreserved embryo transfer. Methods: A systematic review structured according to PRISMA 2020 guidelines. Reproducible searches were conducted in PubMed, Google Scholar, and SciELO, and an equivalent strategy was prepared for Scopus. Primary comparative studies involving women with endometriosis versus controls without endometriosis—with accessible full text and published up to April 30, 2026—were included. Primary outcomes were live birth, cumulative live birth, clinical/ongoing pregnancy, implantation, and miscarriage; secondary outcomes included AMH, antral follicle count (AFC), retrieved and MII oocytes, fertilization, and embryo quality/development. Clinical and methodological heterogeneity prompted a narrative synthesis by outcome. Results: Seventeen primary full-text studies were included. The most consistent finding was reduced ovarian reserve and response in cases of endometriosis, with several studies reporting lower AFC/AMH and fewer oocytes, MII oocytes, or embryos. Fertilization rates and embryo quality were generally comparable after controlling for confounding factors, although some studies on moderate-to-severe endometriosis described morphokinetic alterations or reduced embryonic competence. Clinical outcomes per transfer or per cycle were mostly similar, especially after adjustment for age and ovarian reserve; however, some studies observed lower cumulative live birth rates due to a smaller number of frozen embryos. Evidence regarding miscarriage was inconsistent: a large cohort study found no significant increase, whereas a study on single frozen-thawed blastocyst transfer found higher miscarriage rates, particularly in cases of advanced disease. A registry-based study of 79,318 women published in 2025 showed that endometriosis as an isolated diagnosis did not reduce cumulative live birth rates, whereas its coexistence with other infertility factors did worsen the prognosis. Conclusion: Endometriosis appears to primarily compromise ovarian efficiency and the size of the embryonic cohort, especially in cases of moderate-to-severe disease, endometriomas, and a history of surgery. Once a transferable embryo is obtained, the independent effect on pregnancy and live birth outcomes is minor and heterogeneous. Clinical interpretation must take into account age, ovarian reserve, disease stage, prior surgery, concomitant infertility factors, and the distinction between per-transfer rates and cumulative outcomes.

Keywords: endometriosis; in vitro fertilization; ICSI; assisted reproduction; live birth; pregnancy; ovarian reserve; PRISMA 2020.