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Does moderate to severe endometriosis impact assisted reproductive technology outcomes in women belonging to the POSEIDON 3 and 4 groups? A cohort study

Year: 2026

Type: article

Abstract: ABSTRACT Objective To determine whether reduced oocyte yield, rather than altered oocyte quality or impaired endometrial receptivity, accounts for lower success rates in assisted reproductive technology (ART) among women with endometriosis. Study design This retrospective cohort study included women with diminished ovarian reserve (POSEIDON groups 3 and 4) who underwent ART between January 2011 and December 2023 at a tertiary center in India. Two groups were compared: women with moderate-to-severe endometriosis and prior surgical treatment for endometriomas and women without endometriosis, ovarian surgery, or radiographic evidence of endometriosis. Groups were matched 1:2 for age and BMI using propensity scoring. ART outcomes were compared, and multivariate logistic regression was performed to adjust for potential confounders. Results Women without endometriosis had a significantly higher antral follicle count (4.52±1.78 vs. 5.64±2.96, P =0.003) and longer duration of infertility [6.0 (3.0-8.0) vs.7.0 (4.0-11.0) years, P =0.01]. The number of oocytes retrieved was significantly lower in the endometriosis group [3.5 (2.0–5.0) vs. 4.0 (2.0–7.0), P = 0.027]. Although the cumulative live birth rate (cLBR) per woman (32.1% vs. 19.6%, P = 0.08) and live birth rate (LBR) per completed ART cycle (30.4% vs. 17.9%, P = 0.18) were higher in the endometriosis group, these differences were not statistically significant. After adjusting for potential confounders, women without endometriosis had significantly lower odds of live birth. The adjusted odds ratio for cLBR per woman was 0.34 (95% CI: 0.14–0.81, P = 0.01), and for LBR per completed ART cycle was 0.37 (95% CI: 0.16–0.89, P = 0.02). Conclusions The ART treatment outcomes among women belonging to POSEIDON 3 and 4 who have been surgically treated for moderate to severe endometriosis are not inferior to those of women without endometriosis. Clinical strategies should prioritize optimization of oocyte yield in this population.

Source: European Journal of Obstetrics & Gynecology and Reproductive Biology X

DOI: 10.1016/j.eurox.2026.100503