The Impact Of Endometriosis On Oocyte And Embryo Quality In In Vitro Fertilization/Intracytoplasmic Sperm Injection

BackgroundEndometriosis is closely related to infertility.At present,numerous studies have demonstrated the negative effect of endometriosis,especially endometrioma on female fertility.Assisted reproductive technology(ART)is an effective approach for endometriosis-associated infertility.It’s already acknowledged that oocyte and embryo quality is vital to a successful outcome of ART.In recent years,the issue that the influence of endometriosis,especially endometrioma on oocyte and embryo competence has raised growing attention,nevertheless,the results of these studies are inconclusive.Surgery is the major treatment modality for endometriosis,especially endometrioma when intervention is required.The influence of surgery on ovarian reserve and pregnancy outcome is a common concern in clinical practice.It is a point deserving attention that surgical management of endometriosis,especially endometrioma prior to in vitro fertilization/intracytoplasmic sperm injection(IVF/ICSI).Currently,there are few studies on the effect of surgical treatment of endometrioma on embryo quality in IVF/ICSI.ObjectiveThe study aims to evaluate the impact of endometriosis on embryo quality in in vitro fertilization and intracytoplasmic sperm injection with the use of meta-analysis.This study aims to investigate the effect of endometrioma on oocyte and embryo quality in vitro fertilization and focuses on exploring the impact of surgical treatment prior to in vitro fertilization on embryo competence.Chapter Ⅰ:The impact of endometriosis on embryo quality in in vitro fertilization/intracytoplasmic sperm injection:a meta-analysisMethodsThe literature search was conducted in PubMed,EMBASE,and Web of Science according to the search strategy.The literature selection was performed according to the inclusion and exclusion criteria,for the included studies,data extraction and quality assessment were carried out.The risk ratio with 95%confidence intervals were calculated using the random or fixed effects model.The main outcome measures were high-quality embryo rate,cleavage rate and embryo formation rate.The meta-analysis was performed using Review Manager version 5.4.ResultsA total of 22 studies from the establishment of the databases to August 2020 were included.Compared with the control group,women with endometriosis had a similar high-quality embryo rate(RR=1.00;95%CI,0.94-1.06),a comparable cleavage rate(RR=1.00;95%CI,0.97-1.02)and a similar embryo formation rate(RR=1.10;95%CI,0.97-1.24).In women with stage ⅢⅣ endometriosis,there was no statistically significant difference in high-quality embryo rate(RR=1.02;95%CI,0.94-1.10),cleavage rate(RR=1.00;95%CI,0.98-1.02)and embryo formation rate(RR=1.05;95%CI,0.97-1.14),compared with those without endometriosis.For women with unilateral endometrioma,pooling of results from the affected ovaries did not show a statistically significant difference in high-quality embryo rate(RR=0.99;95%CI,0.60-1.63)in comparison to the normal contralateral ovaries.ConclusionsThe results indicate that endometriosis does not compromise embryo quality in in vitro fertilization and intracytoplasmic sperm injection.Chapter Ⅱ:The impact of endometrioma on oocyte and embryo quality in in vitro fertilizationMethodsThe cohort study retrospectively analysed the data from Reproductive Hospital Affiliated to Shandong University between January 2013 and December 2019.A total of 664 IVF cycles with endometrioma,of which 538 cycles underwent endometrioma-related surgeries,and 3133 IVF cycles with tubal infertility were included in the analysis.The primary outcome was goodquality embryos rate.A 1:1 matching was performed with the use of the propensity score matching.ResultsThere were a lower MII oocytes rate(85.0%versus 87.8%,P<0.001;84.9%versus 87.6%,P=0.001)and a similar good-quality embryos rate in women with endometrioma(as well as those who underwent surgical treatment)compared with control group.For women with endometrioma,the rates of blastocyst development(67.1%versus 60.2%;P=0.013)and good blastocyst development(40.7%versus 35.2%;P=0.049)were significantly higher in those who had prior surgical treatment compared with those who had not,however,the rates of MII oocytes(79.9%versus 87.7%;P<0.001)and normal fertilization(55.2%versus 66.2%;P<0.001)were lower,moreover,the good-quality embryos rate did not differ significantly between the two groups.ConclusionsThe study indicates that endometrioma,including the corresponding surgical treatment,compromises the oocyte maturity not the embryo quality at cleavage stage,however,the surgery seems to be associated with better blastocyst development.