What is the success rate of in vitro fertilization (IVF) in a 31-year-old female with stage 4 endometriosis after one failed IVF cycle using preimplantation genetic testing (PGT)-tested embryos?

From the Guidelines

The success rate for a 31-year-old female with stage 4 endometriosis after one failed IVF cycle with PGT-tested embryos is approximately 40-50% per subsequent embryo transfer. This rate remains relatively favorable due to the patient's young age, which is a significant positive factor in IVF outcomes, as infertility investigations are generally initiated after 12 months of unprotected intercourse without resultant pregnancy in women <35 years of age 1. For patients with severe endometriosis, pre-treatment with 2-3 months of GnRH agonists (such as Lupron 3.75mg monthly injections) before the next embryo transfer may improve success rates by suppressing inflammatory factors associated with endometriosis.

Some key factors to consider in this patient's case include:

• The patient's age, which is a significant factor in determining the success rate of IVF, as deterioration of oocyte quality with increasing maternal age is a common cause of infertility 1
• The presence of stage 4 endometriosis, which affects at least one-third of women with infertility and up to 10% of reproductive-aged women, although the mechanism is unclear 1
• The use of PGT-tested embryos, which eliminates chromosomal abnormalities as a cause of failure
• The potential benefits of endometrial receptivity testing or an ERA (Endometrial Receptivity Array) to determine the optimal timing for embryo transfer, as implantation failure can sometimes be related to transfer timing rather than embryo quality
• The possible benefits of supplementation with vitamin D (1000-2000 IU daily) and omega-3 fatty acids to reduce inflammation

Given the patient's young age and the use of PGT-tested embryos, the prognosis remains relatively good despite severe endometriosis, and further treatment options can be explored to improve success rates.

From the Research

Success Rate of IVF in Women with Endometriosis

• The success rate of IVF in women with endometriosis, specifically those with stage 4 endometriosis, is a topic of ongoing research 2, 3, 4, 5, 6.
• Studies have investigated the use of GnRH agonists and antagonists in IVF cycles for women with endometriosis, with varying results 3, 4, 5.
• A 2020 study found that 3-months of GnRH agonist treatment before IVF did not improve clinical pregnancy rate in women with endometriosis 5.
• Another study published in 2019 found that long-term GnRH agonist therapy versus no pretreatment had uncertain effects on live birth rate and complication rate in women with endometriosis 3.

Factors Affecting IVF Success in Women with Endometriosis

• The quality of evidence on the effectiveness of GnRH agonist therapy in improving IVF outcomes in women with endometriosis is generally low to very low 3.
• Factors such as ovarian stimulation, serum hormone levels, and embryo quality may influence IVF success in women with endometriosis 4, 5, 6.
• The impact of GnRH agonists on prolactin and sex hormone levels in women with endometriosis has also been studied, with findings suggesting a potential decrease in prolactin levels after 8 and 12 weeks of treatment 6.

IVF Outcomes in Women with Stage 4 Endometriosis

• There is limited research specifically addressing the success rate of IVF in women with stage 4 endometriosis after one failed IVF cycle of PGT tested embryo.
• However, studies suggest that women with endometriosis may have lower pregnancy rates and higher cancellation rates compared to those without endometriosis 3, 5.
• Further research is needed to determine the optimal treatment approach for women with stage 4 endometriosis undergoing IVF, including the use of GnRH agonists and antagonists 2, 3, 4, 5, 6.