P–324 Pregnancy outcome after IVF for endometriosis or male infertility: What differs?
Authors: Porcu-buisson G , Chaber. Orsini V , Stefan. Morcillo L , Colomban. Barlesi M , Glowaczower E , Ghione S , Terriou P 
Published: August 2021

Abstract

Study question
Are endometriosis women pregnant after IVF at increased risk of preeclampsia or placenta praevia than patients monitored for male infertility?

Summary answer
Patients with endometriosis are at greater risk than patients monitored for male infertility of developing preeclampsia and placenta previa.

What is known already
Endometriosis is a chronic estrogen-dependent disease that affects women of childbearing age which represents 10% of the general population[.The main symptoms found are chronic pelvic pain, infertility, dyspareunia and dysmenorrhea. Numerous publications have highlighted the deleterious effect of endometriosis on pregnancy i.e miscarriage, placental abnormalities, preeclampsia, preterm birth, low gestational weight. This complication may be related to the molecular and cellular abnormalities present in the endometrium of these patients and to the inflammatory state that may lead to abnormal contractility of the uterus at the time of the implantation window and trophoblastic invasion.

Study design, size, duration
This study is a retrospective, non-interventional monocentric cohort study conducted between January 2011 and December 2017 in Institut de Medecine de la Reproduction - Clinique Bouchard in Marseilles, France.

Participants/materials, setting, methods
The outcome of pregnancies obtained after IVF and/or ICSI in patients with endometriosis (n = 270) was compared with patients,free of endometriosis,monitored for male infertility (n = 366) The statistical study was carried out using GraphPad Version 8 The Student T-test was used to compare means across them. Results were considered significant for p &lt; 0.05.

Main results and the role of chance
Patients with endometriosis and monitored during this period were older than those managed for male infertility. (33.59 vs 32.78) (p = 0.04). There was no difference between the two populations regarding BMI (p = 0.31) or smoking (p &gt; 0.9). The rate of miscarriage observed in the two populations was comparable (25.37 vs. 25.78%) (p &gt; 0.9), so was the rate of IUGR (5.81% vs. 2.29%) despite the observed percentages (p &gt; 0.9). The rate of premature deliveries did not differ between the two populations (18.37% vs. 14.29%) (p = 0.55) neither did the number of children born with a weight &lt;2500g at term (13.68% vs. 12.5%) (p = 0.83). Although the rate of gestational diabetes was comparable in both groups (4.11% vs 4.56%), the rate of preeclampsia was higher in the group of patients with endometriosis with a statistically significant difference (4.79% vs 0.79%) (p = 0.01). Similarly, the rate of placenta previa was higher in patients with endometriosis (4.11% vs 0.76%) (p = 0.02). All pregnancies complicated by placenta previa resulted from J2/J3 embryo transfer. Estradiol levels on the day of induction (2166 pg/ml vs 2452) (p = 0.67) and endometrial thickness was not different between patients with placenta praevia or no (10.45 vs 10.51) (p = 0.66).

Limitations, reasons for caution
Our study is retrospective which may introduce several biases despite the size of our sample i;e patients with endometriosis are older, adenomyosis was not included in the criteria. In our study we have not found any additional risk related to the type of embryo transferred.
Wider implications of the findings: Patients with endometriosis are at greater risk than patients managed for male infertility of developing preeclampsia and placenta previa. It is advisable to warn patients of this possible complication, to promote e-SET and to set up early monitoring in order to place the appropriate management around these patients.

Trial registration number
Not applicable