In endometriosis, fertility treatments work better with reproductive technology

(Reuters Health) - - Women with endometriosis who struggle to conceive may have an easier time getting pregnant when they use fertility treatments that involve assisted reproductive technology (ART), a Japanese study suggests.

In endometriosis, the tissue lining the uterus grows into other organs, often around the ovaries, fallopian tubes and the tissue lining the pelvis. Infertility is common because scarring from the condition can blocks eggs from traveling through the fallopian tubes and may also damage eggs or sperm.

For the study, researchers examined data on two groups of infertile women with advanced endometriosis: 894 who tried to conceive with in vitro fertilization (IVF) or other types of assisted reproductive technology; and 1,358 who tried to conceive with non-ART methods like timed intercourse or intrauterine insemination.

In total, about 49 percent of the women treated with ART gave birth within 18 months of treatment, compared to 22 percent of women using non-ART methods, the study found. Birth rates dropped starting at age 35 and fell sharply at age 40 for both groups of women.

Because these women had much better chances of delivering a baby with ART, the results suggest that women should consider this route before they reach their thirties when their odds of success are higher, said study co-author Dr. Osamu Wada-Hiraike of the University of Tokyo.

“Women suffering from advanced endometriosis should be ready to receive ART treatment while they are young,” Wada-Hiraike said by email.

While the study wasn’t designed to determine why ART might be superior to non-ART approaches for infertile women with endometriosis, it’s possible that reproductive technologies work better by taking over some work normally done by the egg and sperm inside the body.

With ART, egg and sperm are mixed in a lab and then the resulting embryo may be implanted in the uterus, Wada-Hiraike said. By contrast, non-ART approaches may require sperm to reach eggs in the fallopian tube and then require the embryo to reach the uterus unassisted.

“Advanced endometriosis significantly and adversely affects every step of establishing conception,” Wada-Hiraike added. “Thus ART might be helpful because it skips several processes.”

Non-ART approaches tended to be most effective in the first six months of use, while ART appeared to continuously lead to better chances of conception for up to one year, the study also found.

One limitation of the study is that it included too few women in their 20s to determine whether or how ART might differ from non-ART while women are younger, researchers note in the Journal of Obstetrics and Gynaecology Research. Researchers also lacked data on any uterine fibroids women may have had that could have impacted the effectiveness of fertility treatments.

Even so, the results offer fresh evidence that women with endometriosis may not want to postpone any efforts to get help with conception when they struggle to conceive, said Dr. Sarah Maheux-Lacroix of CHU de Quebec, Universite Laval in Canada.

“Unfortunately, in fertility, the clock is always ticking,” Maheux-Lacroix, who wasn’t involved in the study, said by email. “As underlined in this study, the best way to optimize chances of pregnancy in older women with severe endometriosis is sometimes to quickly opt for ART.”

SOURCE: Journal of Obstetrics and Gynaecology Research, online October 2, 2018.