Conception rates of women receiving endometriosis management

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Title of research: O-149 The Endometriosis Longitudinal Fertility Study (ELFS): Outcomes for women with moderate or severe endometriosis who are trying to conceive.

Researchers: Vanessa Ross, Samantha Mooney, Uri Dior, Charlotte Reddington, Claudia Cheng, Michal Amir, Keryn Harlow, Catharyn Stern, Peter Rogers, Martin Healey

Abstract

Study question

What are the pregnancy outcomes for women with moderate or severe endometriosis who are trying to conceive?

Summary answer

Preliminary pregnancy rates in women with moderate/severe endometriosis are 11% for natural conception cycles and 22% for ART cycles. This is consistent with previous literature.

What is already known

Endometriosis is associated with reduced pregnancy rates in women attempting both spontaneous and assisted conception. Monthly fecundity is approximately half that of women without endometriosis and reduces further with increasing severity of disease. At present, the effect of surgery on the fertility outcomes of women with moderate or severe endometriosis remains unanswered. Treatment decisions are complex, particularly in those without pain symptoms seeking to optimise fertility outcomes.

Study design, size, duration

ELFS is a prospective multi-site longitudinal cohort study being conducted over 5-years. This interim report summarises data from August 2021–January 2024 in participants <38 years with evidence of in-situ moderate or severe endometriosis desiring fertility immediately or in the future. ELFS prospectively measures and compares monthly clinical pregnancy and live birth rates in women having either surgical or conservative management of endometriosis. This report assesses outcomes for those trying to conceive naturally or with ART.

Participants/materials, setting, methods

Following consent and baseline questionnaire completion, participants install the purpose-built ELFS App on their mobile phones or use a web-based option to complete cyclical surveys. The timing of surveys is dependent on a learned logic within the App and based on menstrual cycle length and pregnancy status. Participants report attempted conception cycles and any ART treatments undertaken with IVF or intrauterine insemination (IUI). Pregnancy outcomes are recorded as well as surgery during the study period.

Main results and the role of chance

There are 124 participants enrolled in ELFS, 86 (69%) are in the surgical cohort and 38 (31%) in the conservative cohort. There are 45 participants (36%) who have indicated they are actively trying to conceive during the study and a total of 171 cycles have been recorded from these participants. Of those trying to conceive, 24 (53%) elected to have surgery during the study period, compared to 23 (29%) who were not trying to conceive. The study has captured 126 cycles with attempted conception. Of these, 42 cycles (33%) utilised ART compared to 84 cycles (67%) of natural conception attempts. Of the ART cycles, 27 (75%) involved IVF with fresh or frozen embryo transfer and there were 9 (15%) IUI cycles. To date, there are 25 reported pregnancies. The pregnancy rate for ART cycles was 22% (8/36) compared to 11% (9/87) in the natural conception cycles. Of those who conceived following surgery, 47% (8/17) of pregnancies were following ART and 53% (9/17) were natural conceptions. There are 2 live births recorded, both from the cohort who had surgery during the study. A total of 5 miscarriages (20%) have been reported, 4 (80%) from the surgical cohort.

Limitations, reasons for caution

In the absence of data to guide management in this area, clinician scope of practice and concurrent pain symptoms are likely to influence recommendations for ART or surgery in those trying to conceive with moderate or severe endometriosis.

Wider implications of the findings

This preliminary data is consistent with the current literature showing reduced natural and assisted conception rates in women with moderate or severe endometriosis. Long-term data will be required to determine if fertility and pregnancy outcomes are influenced by surgical management of endometriosis.

Reference

V Ross, S Mooney, U Dior, C Reddington, C Cheng, M Amir, K Harlow, C Stern, P Rogers, M Healey. O-149 The Endometriosis Longitudinal Fertility Study (ELFS): Outcomes for women with moderate or severe endometriosis who are trying to conceive. Hum Repro. 2024; 39(1).

Research findings were current at the time of publication. As the fertility landscape evolves, the findings of this study may be superseded by newer research findings. Consult your healthcare professional for medical advice specific to you. 

Impact of COVID-19 on health and psychological wellbeing during fertility treatment

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Title of research: Physical and psychological wellbeing among Australian and New Zealand patients seeking fertility treatment during COVID-19

Researchers: Dr Iolanda S Rodino, A/Prof Sonja Goedeke, A/Prof Melissa Oxlad, Dr Sarah J Nowoweiski

Abstract

Background

Worldwide, COVID-19 has disrupted the provision of fertility treatment and patients’ reproductive plans, resulting in heightened stress for many people seeking to form or expand their families.

Aim

Our study explored health behaviour changes and psychosocial implications of COVID-19 in patients accessing fertility treatment in Australia and New Zealand.

Materials and Methods

Sixty participants (58 female; 2 male) completed an online cross-sectional survey about demographics, fertility history and treatment, changes to physical and mental health status, and perceived support. Participant responses were summarised using descriptive statistics.

Results

Patients indicated that COVID-19 had adversely impacted their fertility treatment experience, including interruptions to treatment owing to fertility clinic closure (70%) and fears about conceiving (68.3%). Patients reported negative health behaviour changes, including a reduction in sleep quality (40%), reduced exercise (40%), weight gain (56.7%) and increases in symptoms of depression (38.3%), anxiety (75%), stress (78.3%) and loneliness (38.3%). Whilst most participants agreed their fertility clinic clearly communicated policy about COVID-19 service changes, including information about availability and/or restrictions, approximately 55% reported being offered nil to very little professional psychological support. When provided professional support, this was most commonly via fertility doctors and nurses (48.3%) compared to counsellors (3.3%).

Conclusion

Commensurate with findings from larger international cohorts, this study highlights the negative impact of COVID-19 on health behaviours and psychological wellbeing. Moreover, given the ever-changing landscape of COVID-19, our study underscores the importance of promoting and utilising fertility clinic counselling services to enhance patient psychological care during this unprecedented pandemic.

Reference

Rodino IS, Goedeke S, Oxlad M, Nowoweiski SJ. Physical and psychological wellbeing among Australian and New Zealand patients seeking fertility treatment during COVID-19. Aust Psychol. 2023; 58(5): 336–345.

Research findings were current at the time of publication. As the fertility landscape evolves, the findings of this study may be superseded by newer research findings. Consult your healthcare professional for medical advice specific to you.