Endometriosis and IVF: Clinical, Surgical, and Biological Factors Affecting Outcomes

Background Endometriosis, particularly endometriotic cysts (endometriomas), is commonly related to infertility in women. In vitro fertilization (IVF) is a widely used treatment for these patients; however, its outcomes can be influenced by various factors. This retrospective study aimed to investigate the factors affecting IVF outcomes in women with endometriomas. Methods This retrospective study included 83 women who underwent IVF between May 2021 and April 2024. Various factors were assessed, including ovarian reserve (measured by anti-Müllerian hormone [AMH] levels), age, presence of bilateral endometriomas, surgical management of endometrioma, size of endometriomas, and ovarian stimulation protocols (antagonist & agonist flare). Multivariable linear and logistic regression analyses were performed to determine the relationships between these variables and IVF outcomes, including the number of oocytes retrieved and clinical pregnancy rates. Results Among the ovarian response parameters, the Ovarian Stimulation Index (OSI) showed the strongest correlation with both the number of oocytes (r = 0.886) and mature oocytes (r = 0.809), suggesting its reliability in assessing the ovarian response in women with endometriosis. AMH levels were a significant positive predictor of the number of oocytes retrieved (β = 3.210, 95% CI: 2.670, 3.752, p < 0.001). Conversely, age and the presence of bilateral endometriomas were negatively associated with oocyte retrieval (age: β = -0.1879, 95% CI: -0.397, 0.021, p = 0.07; bilateral endometriomas: β = -1.9670, 95% CI: -3.519, -0.415, p = 0.014). Surgical management and endometrioma size did not significantly affect the oocyte retrieval. Age was also a significant negative predictor of clinical pregnancy (β = -1.329, 95% CI: -1.955, -0.704, p < 0.001). Conclusion This study highlights the importance of ovarian reserve and age as significant factors influencing IVF outcomes in women with endometriotic cysts. The choice of ovarian stimulation protocol did not appear to significantly affect oocyte retrieval. Tailored IVF treatment strategies should focus on these factors to optimize results. Additionally, the ovarian sensitivity index (OSI) is a reliable tool for assessing ovarian response in these patients.