What are the implications of endometriosis on In Vitro Fertilization (IVF) transfer failure?

From the Guidelines

Failed IVF transfers are common with endometriosis, and for your next attempt, consider discussing with your doctor about endometriosis suppression before transfer, typically using GnRH agonists like Lupron for 2-3 months, as this approach has been shown to improve implantation rates in women with endometriosis 1. When it comes to endometriosis and IVF, the goal is to optimize the chances of successful implantation and pregnancy.

• Endometriosis can affect implantation through inflammation, altered immune response, and poor endometrial receptivity, making it essential to address these factors before the next IVF attempt.
• Some specialists recommend laparoscopic excision of endometriosis lesions before IVF to improve success rates, as this can help reduce inflammation and improve endometrial receptivity.
• Additional treatments might include medications to improve endometrial receptivity, such as low-dose aspirin (81mg daily), pentoxifylline (400mg twice daily), or immune modulators like prednisone (5-10mg daily during stimulation and early pregnancy) 1.
• Endometrial scratching performed in the cycle before transfer may also help in some cases, as it can stimulate the endometrium and improve implantation rates.
• Nutritional supplements like vitamin D (1000-2000 IU daily) and omega-3 fatty acids might reduce inflammation and improve overall fertility.
• It's also crucial to discuss with your doctor about adjusting your protocol, possibly including more aggressive progesterone support or extended embryo culture to blastocyst stage, as these approaches can help optimize the chances of successful implantation and pregnancy.
• Remember that multiple factors affect IVF success, and sometimes several attempts are needed even with optimal treatment, so it's essential to be patient and work closely with your healthcare provider to develop a personalized plan. The diversity in outcome reporting in IVF trials, as highlighted in a review of outcome measures in IVF RCTs 1, underscores the importance of standardizing outcome measures to better understand the effectiveness of different treatments and improve patient care.

From the Research

IVF Transfer Failure and Endometriosis

• Endometriosis is a common inflammatory disease in women of reproductive age and is one of the major causes of infertility 2.
• The severity of endometriosis is related to ovarian reserve, and surgical treatment of endometriosis can lead to ovarian injury during the resection of endometriotic tissue, which leads to the deterioration of ovarian reserve 2.
• In cases of mild- to moderate-stage endometriosis, intrauterine insemination with ovarian stimulation after surgical treatment may increase the likelihood of pregnancy 2.
• The presence of severe endometriosis (stage III/IV) is associated with poor implantation and clinical pregnancy rates in women undergoing IVF treatment 3.

Impact of Endometriosis on IVF Outcomes

• Fertilisation rates were reduced in stage I/II of endometriosis, and there was a decrease in the implantation rate and clinical pregnancy rate in women with stage III/IV endometriosis undergoing IVF treatment 3.
• The quality of embryos was comparable in women with endometriosis-associated infertility and those with tubal factor infertility, but the implantation rate was significantly lower in the endometriosis group 4.
• Long-term GnRH agonist therapy before IVF may not improve pregnancy outcomes in women with endometriosis, and further high-quality trials are required to definitively determine the impact of this therapy 5.

Treatment Options for Endometriosis-Associated Infertility

• Management options for endometriosis-associated infertility include surgery, in-vitro fertilization (IVF), or a combination of both 6.
• The approach to the patient with endometriosis and infertility should be tailored based on different parameters, including the localization of the disease, the severity of symptoms, and the age of the patient 6.
• Laparoscopic excision of the ovarian endometrioma should be the treatment of choice when there is associated pain, and surgery should be performed following appropriate techniques to reduce the possible damage to the ovarian reserve 6.