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Impact of Endometriosis Surgery on In Vitro Fertilization/Intracytoplasmic Sperm Injection Outcomes: a Systematic Review and Meta-analysis

  • Infertility: Review
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Abstract

Endometriosis-related infertility remains a therapeutic challenge. A burning issue in this field of research is determining whether pre-assisted reproductive technology (ART) surgery may be of some benefit in terms of reproductive outcomes. This systematic review and meta-analysis aimed at comparing ongoing pregnancy rates (OPR) and/or live birth rates (LBR) in patients who underwent endometriosis surgery before ART (IVF/ICSI) in comparison with patients who underwent first-line ART (IVF/ICSI). Searches were conducted from January 1990 to June 2021 on PubMed, Embase, and Cochrane Library using the following search terms: endometriosis, surgery, reproductive outcomes, and IVF/ICSI. The primary outcomes were OPR or LBR. A total of 19 studies were included in the meta-analysis. No statistically significant differences in LBR [0.91[0.63, 1.30]; I2 = 66%; n = 11], OPR [1.28[0.66, 2.49]; I2 = 60%; n = 3], and early pregnancy loss rate [0.88[0.62, 1.25]; I2 = 0%; n = 7] per cycle were found when comparing patients who underwent endometriosis surgery before IVF/ICSI and those who did not. After the exclusion of the studies with high risks of bias, the LBR per cycle was significantly reduced in the case of surgical treatment before IVF/ICSI [0.53[0.33, 0.86]; I2 = 30%; n = 4]. These data urge the clinician to carefully weigh the pros and cons before referring infertile patients with endometriosis to surgery before IVF, highlighting the key role of multidisciplinary referral centers.

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Acknowledgements

We thank the Inter-university Library of Medicine (BIUM) of Paris for methodological support. We thank Dr. Garcia Velasco, Dr. Maignien, and Dr. Rubod for providing us with detailed data on LBR for their studies. This work was sponsored by an unrestricted grant from Gedeon Richter, France. The funder provided support in the form of salaries for one of the authors (CS). CS revised the manuscript. The funder did not have any additional role in the study design, study selection and analysis, and decision to submit the article for publication.

Funding

This work was supported by Gedeon Richter France.

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  1. Department of Gynecology Obstetrics II and Reproductive Medicine (Professor Chapron), Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, Université de Paris Cité, Faculté de Santé, Paris, France

    M. Bourdon, C. Maignien & Pietro Santulli

  2. Department 3I “Infection, Immunité Et Inflammation”, Institut Cochin, INSERM U1016, Paris, France

    M. Bourdon & Pietro Santulli

  3. Department of Reproductive Médecine and Fertility Preservation, AP-HP, Hopital Jean Verdier, Université Sorbonne Paris Nord, Faculté de Santé, Bondy, France

    M. Peigné

  4. Department of Gynecology Obstetrics and Reproductive Medicine, CHU de Poitiers, Poitiers, France

    D. de Villardi de Montlaur

  5. Gedeon Richter France, 75008, Paris, France

    C. Solignac

  6. Monitoring Force, 78600, Maisons-Laffitte, France

    B. Darné & S. Languille

  7. Department of Gynecology Obstetrics and Reproductive Medicine, AP-HP, Hôpital Tenon, Hôpitaux Universitaires Est Parisien, Faculté de Santé, Paris, France

    S. Bendifallah

Authors
  1. M. Bourdon
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  2. M. Peigné
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  3. C. Maignien
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  4. D. de Villardi de Montlaur
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  5. C. Solignac
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  6. B. Darné
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  7. S. Languille
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  8. S. Bendifallah
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  9. Pietro Santulli
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Contributions

M.B., M.P., and P.S. substantially contributed to the conception and design of the study, acquisition of data, and analysis and interpretation of data, drafted the article, gave their final approval of the version to be published, and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

C.S. substantially contributed to the acquisition of data, revised the article, gave her final approval of the version to be published, and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

D.D.V.D.M. and S.B substantially contributed to the acquisition of data, drafted the article, gave their final approval of the version to be published, and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

B.D and S.L. substantially contributed to the conception and design, data management, analysis, and interpretation of data, drafted and revised the article critically for important intellectual content, gave their final approval of the version to be published, and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Pietro Santulli.

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Date of PROSPERO registration: 2021, 11 May; Registration number: CRD42021253444.

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The authors declare no competing interests.

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Supplementary Information

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Supplementary file1 (TIFF 16694 KB) Supplementary Figure 1: Risk of bias according to ROBINS-1

43032_2023_1421_MOESM2_ESM.tiff

Supplementary file2 (TIFF 1422 KB) Supplementary Figure 2: Forest plots of studies of surgery versus no surgery before IVF/ICSI for endometriosis for Live birth rate (LBR) per transfer. M–H, Mantel–Haenszel method; Risks of bias legend: A, Confounding factors; B, Selection of participants; C, Classification of intervention; D, Deviation from intervention; E, Missing data; F, Measurement of outcome; G, Selection of reported results.

43032_2023_1421_MOESM3_ESM.tiff

Supplementary file3 (TIFF 231 KB) Supplementary Figure 3: Forest plots of studies of surgery versus no surgery before IVF/ICSI for endometriosis: (A) Ongoing pregnancy rate (OPR) per cycle, (B) OPR per transfer and (C) cumulative OPR. M–H, Mantel–Haenszel method; Risks of bias legend: A, Confounding factors; B, Selection of participants; C, Classification of intervention; D, Deviation from intervention; E, Missing data; F, Measurement of outcome; G, Selection of reported results.

43032_2023_1421_MOESM4_ESM.tiff

Supplementary file4 (TIFF 449 KB) Supplementary Figure 4: Forest plots of studies of surgery versus no surgery before IVF/ICSI for endometriosis: (A) Clinical pregnancy rate (CPR) per cycle, (B) CPR per transfer and (C) cumulative CPR. M–H, Mantel–Haenszel method; Risks of bias legend: A, Confounding factors; B, Selection of participants; C, Classification of intervention; D, Deviation from intervention; E, Missing data; F, Measurement of outcome; G, Selection of reported results.

43032_2023_1421_MOESM5_ESM.tiff

Supplementary file5 (TIFF 472 KB) Supplementary Figure 5: Forest plots of studies of surgery versus no surgery before IVF/ICSI for endometriosis: (A) Early pregnancy loss (EPL) per cycle and (B) EPL per transfer. M–H, Mantel–Haenszel method; Risks of bias legend: A, Confounding factors; B, Selection of participants; C, Classification of intervention; D, Deviation from intervention; E, Missing data; F, Measurement of outcome; G, Selection of reported results.

Supplementary file6 (DOCX 14 KB)

Supplementary file7 (DOCX 13 KB)

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Bourdon, M., Peigné, M., Maignien, C. et al. Impact of Endometriosis Surgery on In Vitro Fertilization/Intracytoplasmic Sperm Injection Outcomes: a Systematic Review and Meta-analysis. Reprod. Sci. (2024). https://doi.org/10.1007/s43032-023-01421-7

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