Assisted Reproductive Technology in Women With Endometriosis and a History of Catamenial Pneumothorax: Reproductive...

To describe reproductive outcomes and clinical safety considerations associated with assisted reproductive technology (ART) in women with a history of surgically treated catamenial pneumothorax (CP) (thoracic endometriosis syndrome).

Retrospective case series conducted from January 2014 to December 2023.

Single tertiary academic center integrating reproductive medicine and thoracic surgery.

Women aged 18 to 43 years with surgically treated CP were included.

Exposure was ART in women with CP ultimately managed surgically, performed either before and/or after the thoracic operation; the timing of ART relative to surgery was recorded.

Primary outcomes were reproductive outcomes (including live birth rate per patient and per transfer) and safety outcomes (pneumothorax occurrence/recurrence and ART-related complications). Ten of the 11 patients (91%) had right-sided CP. Five women (45%) had undergone pelvic endometriosis surgery before thoracic management. Nineteen ovarian stimulation cycles were performed. Among infertile patients, seven of 10 (70%) achieved at least one live birth: five after in vitro fertilization with autologous oocytes, one after oocyte donation, and one after intrauterine insemination with donor sperm. Four women (36%) experienced their first pneumothorax episode within 4 months of ART. No thoracic recurrences were observed after surgery, despite subsequent ovarian stimulations.

ART was associated with positive reproductive outcomes and a low rate of reported adverse events in women with a history of surgically treated CP, with no observed thoracic recurrences following treatment. Prospective studies are needed to further characterize outcomes and risks.