JBRA Assisted Reproduction 2025;29(Suppl.2 SBRA 2025):141
Poster Presentation
29^th Annual Congress of the SBRA. São Paulo/SP - Brazil, 2025
doi: 10.5935/1518-0557.20263778

P-129. Impact of Deep Infiltranting Endometriosis on embryo quality - viable blastocyst rate - and reproductive outcomes in women undergoing In Vitro Fertilization (IVF)

Jullia Almeida Menezes¹, Ana Carolina Izabel Menecucci¹, Drielly Dos Reis Franzoi¹, Samara Batista De Jesus¹, Maria Monica Pereira¹

¹ Centro Universitário São Camilo - São Paulo - SP - Brasil

Objective: To evaluate the impact of deep infiltrating endometriosis (DIE) on embryo quality - specifically the viable blastocyst rate - and on reproductive outcomes such as implantation, clinical pregnancy, and live birth rates, in women undergoing In Vitro Fertilization (IVF).
Methods: A bibliographic literature review was conducted to answer: “Does DIE reduce viable blastocyst rates in women undergoing IVF compared to those without endometriosis?”. The search was performed on July 10th across PubMed, Virtual Health Library (VHL/BVS) and Cochrane Library. The main descriptors (MeSH and DeCS) used were “endometriosis,” “blastocyst,” “embryo quality,” and “in vitro fertilization” combined with Boolean operators (AND/OR). Inclusion criteria comprised articles published in the last 10 years; study types as cohort studies, case-control studies, randomized controlled trials and reviews; and studies that followed the PECO strategy - population: women with infertility undergoing IVF; exposure: presence of DIE; comparison: women undergoing IVF without endometriosis or with other infertility causes; outcome: embryo quality, specifically viable blastocyst rate. As exclusion criteria: articles unavailable in full text or unrelated themes.
Results: The search yielded 245 articles, and only 9 were included in the review. Regarding embryo quality, findings were heterogeneous. Several found no statistically significant differences in high-quality blastocysts rates between women with and without endometriosis, while one study reported impaired embryonic morphology in the DIE group. Fertilization rates were generally preserved in women with endometriosis, especially when intracytoplasmic sperm injection (ICSI) was used. However, conventional IVF cycles showed decreased fertilization rates in advanced endometriosis, possibly related to the lower number of oocytes retrieved. Implantation rates showed divergent results among studies. One study revealed a slight nonsignificant reduction in women with endometriosis (36%) versus control group (40%), while another reported a larger decrease (18.3% vs. 31.4%). Clinical pregnancy and live birth rates differed by disease severity, patients with mild endometriosis showed outcomes similar to women without the disease. In contrast, DIE or advanced-stage endometriosis was associated with a reducted clinical pregnancy rates, though some studies found no statistically significant differences in these outcomes. Miscarriage rates was consistently higher in women with endometriosis, specifically, among those with DIE, one study reported an incidence of 19.7% in the affected group, compared to 7.3% in the control group; another found rates of 16% and 12.2%, respectively. From a pathophysiological perspective, elevated inflammatory cytokines, such as interleukins, may impair oocyte and embryo quality. Additionally, higher serum of follicle-stimulating hormone and prolactin were identified in patients with advanced endometriosis, reflecting disease progression and diminished ovarian reserve. Only one study addressed viable blastocyst rates, but no statistically significant differences were found between women with endometriosis and the control group.
Conclusion: This review suggests that deep infiltrating endometriosis (DIE) may negatively affect IVF outcome, with reduced clinical pregnancy and live birth rates, and increased miscarriage risk. Evidence on embryo quality, particularly viable blastocyst rate, is scarce and inconclusive, as most studies evaluated only general embryo morphology, with only one study addressing it directly and finding no significant difference. Fertilization rates seem preserved in ICSI, but conventional IVF may be less efficient due to lower oocyte yield in DIE. Further well designed studies focusing on viable blastocyst rates are needed to guide treatment strategies.