Association of Endometriosis with Ovarian Reserve, Controlled Ovarian Stimulation, and Embryological Outcomes in Women Undergoing Intracytoplasmic Sperm Injection: A Retrospective Comparative Study
DOI:
https://doi.org/10.65761/pjcr.2026.46Keywords:
Endometriosis, Infertility, Intracytoplasmic Sperm Injection, In Vitro Fertilization, Ovarian Reserve, Anti-Müllerian Hormone, Pregnancy Rate.Abstract
Background: Endometriosis is a chronic inflammatory gynecological disorder frequently associated with infertility. Although intracytoplasmic sperm injection (ICSI) is widely used to overcome infertility, the independent impact of endometriosis on ICSI outcomes in women without previous ovarian surgery remains uncertain.
Objective: To investigate the effect of endometriosis on ICSI outcomes among infertile women without a previous history of ovarian surgery.
Methods: This retrospective comparative study was conducted at the Department of Obstetrics and Gynecology, Hayatabad Medical Complex, Peshawar, Pakistan, from February 2025 to November 2025. A total of 190 infertile women undergoing IVF/ICSI were included and divided equally into an endometriosis group (n=95) and a control group (n=95). Baseline characteristics, ovarian reserve markers, stimulation parameters, embryological findings, and clinical pregnancy outcomes were compared using independent-samples t-test and chi-square test. A p-value <0.05 was considered statistically significant.
Results: Women with endometriosis had significantly lower body mass index, antral follicle count, and anti-Müllerian hormone levels, while basal follicle-stimulating hormone and prolactin levels were significantly higher (p<0.05). They required greater gonadotropin doses and longer ovarian stimulation despite producing fewer follicles, retrieved oocytes, mature metaphase II oocytes, and fertilized oocytes (all p<0.001). However, fertilization rate (76.5% vs. 78.1%; p=0.328), good-quality embryo rate (61.1% vs. 64.2%; p=0.664), implantation rate (29.8% vs. 30.6%; p=0.812), and clinical pregnancy rate (32.0% vs. 31.0%; p=0.874) were comparable between groups.
Conclusion: Endometriosis adversely affected ovarian reserve and ovarian response during controlled stimulation but did not significantly compromise embryo quality or clinical pregnancy outcomes following ICSI in women without previous ovarian surgery.
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