Does polycystic morphology beneficially influence ART outcomes in women with endometriosis? A cohort study

Is co-existing polycystic ovarian morphology (PCOM) associated with a higher cumulative live birth rate (LBR) after assisted reproductive technology (ART) in women with advanced endometriosis?

A retrospective cohort study at the Christian Medical College and Hospital, Vellore, India. The study population was divided into three groups: women with moderate or severe endometriosis alone, women with a combination of moderate or severe endometriosis and co-existing PCOM and a control consisting of women with PCOM alone (without advanced endometriosis). The study groups were matched according to age, body mass index and year of treatment using propensity score matching. The primary outcome was cumulative LBR.

The women with endometriosis alone had significantly lower cumulative live birth per woman compared with the women with endometriosis and PCOM (26.2% versus 52.3%, P < 0.001) and the women with PCOM alone (48.6%, P = 0.001). Logistic regression revealed that women with endometriosis alone had significantly lower odds of achieving a cumulative LBR (adjusted OR 0.51, 95% CI 0.3 to 0.9), compared with the women with PCOM alone. No differences, however, were observed in the odds of achieving a cumulative live birth (adjusted OR 1.17, 95% CI 0.7 to 2.1) in women with endometriosis and PCOM compared with the reference group, i.e. women with PCOM.

In women with advanced endometriosis, a co-existing PCOM is associated with improved ART outcomes compared with women with moderate to severe endometriosis alone, probably because of a relatively higher oocyte yield.