L26/O-212 The presence of ovarian endometrioma adversely affect the IVF/ ICSI outcomes: a multicenter propensity score–matched study

Abstract Study question To evaluate the impact of endometrioma on IVF/ICSI outcomes in patient underwent IVF/ICSI, taking into account of subsequent vitrified embryo transfers. Summary answer In women undergoing IVF, endometrioma was associated with a lower CLBR. What is known already Endometriomas are well-konwn to suppress IVF/ICSI outcomes. However, existing literature remains controversial regarding their independent impact on oocyte quality, implantation potential, and specifically cumulative live birth rates (CLBR), necessitating large-scale controlled analyses to clarify these long-term prognosis outcomes. Study design, size, duration This multicenter retrospective cohort study was conducted in university-affiliated hospitals or large academic hospitals in China, including infertile patients undergoing their first IVF/ICSI cycle. Propensity score (PS) matching was conducted to tackle the large gap of multiple maternal factors between the cohorts. Participants/materials, setting, methods The primary outcome was the cumulative live birth rate (CLBR) within two years of oocyte retrieval. A comprehensive statistical analysis was performed, utilizing generalized estimated equation regression for per-transfer outcomes. The CLBR was evaluated using Kaplan-Meier curves with a log-rank test, and a Cox proportional hazard model was used to assess the independent prognostic significance of endometrioma. Subgroup analyses were also conducted based on age, AFC, and stimulation protocol. Main results and the role of chance Following propensity score matching, 2260 women in the endometrioma group were matched to 6750 women in the control group. The AMH(4.27±3.53 vs 4.68±3.23, p < 0.01), AFC(11.18±5.06 vs 13.68±5.32, p < 0.01) were significantly lower in the endometrioma group than in the control group. The endometrioma group had significantly lower implantation rates(50.0% vs. 53.2%), clinical pregnancy rates per transfer (63.1% vs. 65.5%), and live birth rates per transfer (46.2% vs. 49.3%). Using the Kaplan-Meier analysis, the cumulative incidence of ongoing pregnancy leading to live birth was significantly lower in the endometrioma group than in the control group (57.1% vs 61.9%, HR:0.87, 95% CI: 0.81-0.92) (Figure 1). A Cox proportional hazard model revealed that women who had endometrioma were 0.815 times less likely to achieve a live birth (HR:0.82; 95% CI: 0.76-0.87). Subgroup analysis revealed that women who had endometrioma were less likely to achieve a live birth across the younger strata (aged < =35 years) (59.2% vs 64.8%, HR:0.86, 95% CI: 0.80-0.92), and 1 AFC strata (AFC>5) (58.8% vs 62.7%, HR:0.89, 95% CI: 0.83-0.95). Limitations, reasons for caution The retrospective design introduces selection biases, despite rigorous propensity score matching. Wider implications of the findings These findings suggest endometrioma impairs IVF outcomes beyond mere reserve diminution, likely affecting oocyte quality or endometrial receptivity. Clinicians should provide realistic counseling regarding reduced cumulative success rates, particularly for younger patients and those with normal AFC who might otherwise overestimate their prognosis. Trial registration number No