Endometriosis, especially mild disease: a risk factor for miscarriages.

Area of Science:

• Reproductive Medicine
• Gynecology
• Obstetrics

Background:

• Endometriosis is a chronic inflammatory condition affecting women of reproductive age.
• The impact of endometriosis on pregnancy outcomes, specifically miscarriage, requires further investigation.
• Understanding this association is crucial for improving reproductive health management in affected women.

Purpose of the Study:

• To compare the prevalence of miscarriage in women with endometriosis (WwE) against disease-free control women (CW).
• To analyze miscarriage rates based on fertility status, endometriosis severity (rASRM stages), and lesion location.

Main Methods:

• A cross-sectional analysis was conducted within a retrospective observational study of 940 women.
• Previously pregnant women (n=268) were analyzed in matched pairs.
• Data were collected through retrospective analysis of surgical reports and self-administered questionnaires.

Main Results:

• The miscarriage rate was significantly higher in WwE (35.8%) compared to CW (22.0%), with an adjusted incidence risk ratio of 1.97.
• This elevated risk persisted in subfertile WwE (50.0%) but not in fertile WwE (24.5%).
• Higher miscarriage rates were observed in women with milder endometriosis (rASRM I/II: 42.1%) and superficial peritoneal lesions (42.0%) compared to CW.

Conclusions:

• Endometriosis is associated with an increased risk of miscarriage.
• Mild endometriosis, particularly superficial lesions, may contribute to miscarriage risk through inflammatory pathways affecting folliculogenesis, fertilization, or implantation.
• Further research into the mechanisms underlying endometriosis-related miscarriage is warranted.