Endometriosis, especially mild disease: a risk factor for miscarriages.
- Kohl Schwartz AS Department of Reproductive Endocrinology, University Hospital Zurich, Zurich, Switzerland; Division of Gynecological Endocrinology and Reproductive Medicine, Bern University Hospital, University of Bern, Bern, Switzerland. Electronic address: alexandra.kohlschwartz@usz.ch.
- Wölfler MM Division of Gynecological Endocrinology and Reproductive Medicine, Medical University of Graz, Graz, Austria; Department of Obstetrics and Gynecology, RWTH Aachen University Hospital, Aachen, Germany.
- Mitter V Division of Gynecological Endocrinology and Reproductive Medicine, Bern University Hospital, University of Bern, Bern, Switzerland.
- Rauchfuss M Department of Psychosomatics, Charité University Hospital Berlin, Berlin, Germany.
- Haeberlin F Women's Hospital, Cantonal Hospital St. Gallen, St. Gallen, Switzerland.
- Eberhard M Women's Hospital, Cantonal Hospital Schaffhausen, Schaffhausen, Switzerland.
- von Orelli S Maternité, Stadtspital Triemli, Zurich, Switzerland.
- Imthurn B Department of Reproductive Endocrinology, University Hospital Zurich, Zurich, Switzerland.
- Imesch P Department of Gynecology, University Hospital Zurich, Zurich, Switzerland.
- Fink D Department of Gynecology, University Hospital Zurich, Zurich, Switzerland.
- Leeners B Department of Reproductive Endocrinology, University Hospital Zurich, Zurich, Switzerland.
- 2017-10-29
Published in:
- Fertility and sterility. - 2017
Endometriosis
infertility
miscarriage
pregnancy outcome
superficial peritoneal endometriosis
Abortion, Spontaneous
Adolescent
Adult
Cross-Sectional Studies
Endometriosis
Europe
Female
Fertility
Humans
Infertility, Female
Middle Aged
Odds Ratio
Pregnancy
Prevalence
Retrospective Studies
Risk Assessment
Risk Factors
Severity of Illness Index
Young Adult
English
OBJECTIVE
To investigate the prevalence of miscarriage in women with endometriosis (WwE) compared with disease-free control women (CW).
DESIGN
Cross-sectional analysis nested in a retrospective observational study (n = 940).
SETTING
Hospitals and associated private practices.
PATIENT(S)
Previously pregnant women (n = 268) within reproductive age in matched pairs.
INTERVENTION(S)
Retrospective analysis of surgical reports and self-administered questionnaires.
MAIN OUTCOME MEASURE(S)
Rate of miscarriage, subanalysis for fertility status (≤12 vs. >12 months' time to conception), endometriosis stages (revised American Society of Reproductive Medicine classification [rASRM] I/II vs. III/IV) and phenotypic localizations (superficial peritoneal, ovarian, and deep infiltrating endometriosis).
RESULT(S)
The miscarriage rate was higher in WwE (35.8% [95% confidence interval 29.6%-42.0%]) compared with CW (22.0% [16.7%-27.0%]); adjusted incidence risk ratio of 1.97 (95% CI 1.41-2.75). This remained significant in subfertile WwE (50.0% [40.7%-59.4%]) vs. CW (25.8% [8.5%-41.2%]) but not in fertile WwE (24.5% [16.3%-31.6%]) vs. CW (21.5% [15.9%-26.8%]). The miscarriage rate was higher in women with milder forms (rASRM I/II 42.1% [32.6%-51.4%] vs. rASRM III/IV 30.8% [22.6%-38.7%], compared with 22.0% [16.7%-27.0%] in CW), and in women with superficial peritoneal endometriosis (42.0% [32.0%-53.9%]) compared with ovarian endometriosis (28.6% [17.7%-38.7%]) and deep infiltrating endometriosis (33.9% [21.2%-46.0%]) compared with CW (22.0% [16.7%-27.0%]).
CONCLUSION(S)
Mild endometriosis, as in superficial lesions, is related to a great extent of inflammatory disorder, possibly leading to defective folliculogenesis, fertilization, and/or implantation, presenting as increased risk of miscarriage.
CLINICAL TRIAL REGISTRATION NUMBER
NCT02511626.
To investigate the prevalence of miscarriage in women with endometriosis (WwE) compared with disease-free control women (CW).
DESIGN
Cross-sectional analysis nested in a retrospective observational study (n = 940).
SETTING
Hospitals and associated private practices.
PATIENT(S)
Previously pregnant women (n = 268) within reproductive age in matched pairs.
INTERVENTION(S)
Retrospective analysis of surgical reports and self-administered questionnaires.
MAIN OUTCOME MEASURE(S)
Rate of miscarriage, subanalysis for fertility status (≤12 vs. >12 months' time to conception), endometriosis stages (revised American Society of Reproductive Medicine classification [rASRM] I/II vs. III/IV) and phenotypic localizations (superficial peritoneal, ovarian, and deep infiltrating endometriosis).
RESULT(S)
The miscarriage rate was higher in WwE (35.8% [95% confidence interval 29.6%-42.0%]) compared with CW (22.0% [16.7%-27.0%]); adjusted incidence risk ratio of 1.97 (95% CI 1.41-2.75). This remained significant in subfertile WwE (50.0% [40.7%-59.4%]) vs. CW (25.8% [8.5%-41.2%]) but not in fertile WwE (24.5% [16.3%-31.6%]) vs. CW (21.5% [15.9%-26.8%]). The miscarriage rate was higher in women with milder forms (rASRM I/II 42.1% [32.6%-51.4%] vs. rASRM III/IV 30.8% [22.6%-38.7%], compared with 22.0% [16.7%-27.0%] in CW), and in women with superficial peritoneal endometriosis (42.0% [32.0%-53.9%]) compared with ovarian endometriosis (28.6% [17.7%-38.7%]) and deep infiltrating endometriosis (33.9% [21.2%-46.0%]) compared with CW (22.0% [16.7%-27.0%]).
CONCLUSION(S)
Mild endometriosis, as in superficial lesions, is related to a great extent of inflammatory disorder, possibly leading to defective folliculogenesis, fertilization, and/or implantation, presenting as increased risk of miscarriage.
CLINICAL TRIAL REGISTRATION NUMBER
NCT02511626.
- Language
-
- English
- Open access status
- bronze
- Identifiers
-
- DOI 10.1016/j.fertnstert.2017.08.025
- PMID 29079275
- Persistent URL
- https://sonar.ch/global/documents/155542
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