Women with advanced-stage endometriosis and previous surgery respond less well to gonadotropin stimulation, but have similar IVF implantation and delivery rates compared with women with tubal factor infertility

Objective: To investigate the response to controlled ovarian hyperstimulation and ART outcomes in women with advanced-stage endometriosis and previous surgeries at the Yale IVF program between 1996 and 2002. Design: Retrospective case control study. Setting: Academic medical center. Patient(s): The study group consisted of 68 women who previously undergone laparoscopic surgery for advanced-stage endometriosis. The control group included 106 women with tubal-factor infertility. The women with endometriosis underwent 133 IVF-ET cycles and the control group 208 cycles. Intervention(s): Controlled ovarian hyperstimulation and IVF-ET. Main Outcome Measure(S): Response to gonadotropins, fertilization, cleavage, implantation, pregnancy, miscarriage, and live birth rates. Result(S): Lower peak E-2 levels, higher total gonadotropin requirements, lower oocyte yield, and higher cancellation rates were found in women with endometriosis compared with tubal-factor control subjects. However, no differences were found in fertilization, cleavage, implantation, pregnancy, miscarriage, and delivery rates between the endometriosis and tubal-factor groups. Conclusion(s)(S): Women with advanced-stage endometriosis who have undergone previous surgery respond less well to gonadotropins than women with tubal-factor infertility. However, implantation, pregnancy, and delivery rates are similar, suggesting that embryo quality and uterine receptivity remains unaffected despite diminished ovarian reserve in women with endometriosis. (Fertil Steril((R)) 2007;88:1568-72. (c) 2007 by American Society for Reproductive Medicine.)