Reproductive, obstetric, and perinatal outcomes of women with adenomyosis and endometriosis: a systematic review and meta-analysis.
Level 3 - non-randomized controlled study
Systematic review and meta-analysis of observational and comparative studies
PubMed 31318420 · doi:10.1093/humupd/dmz012
What was done
A systematic literature review was conducted across NHS Evidence databases and the Cochrane database covering comparative and observational studies from 1980 through December 2018 without language restriction. The authors evaluated the relationship of adenomyosis and endometriosis with fertility, obstetric, and neonatal outcomes across natural conception and assisted reproduction, as well as disease subtype effects. Quality and bias were assessed using the Downs and Black checklist across 104 included papers.
What was found
Milder endometriosis was associated with reduced fertilization rates (OR 0.77, 95% CI 0.63–0.93) and implantation rates (OR 0.76, 95% CI 0.62–0.93), while severe disease (ASRM III–IV) affected all reproductive stages. Ovarian endometriosis reduced oocyte yield (MD -1.22, 95% CI -1.96 to -0.49) and mature oocytes (MD -2.24, 95% CI -3.4 to -1.09). Miscarriage risk was elevated in both adenomyosis (OR 3.40, 95% CI 1.41–8.65) and endometriosis (OR 1.30, 95% CI 1.25–1.35). Endometriosis was also linked to increased rates of preterm delivery (OR 1.38, 95% CI 1.01–1.89), cesarean delivery (OR 1.98, 95% CI 1.64–2.38), and neonatal unit admission (OR 1.29, 95% CI 1.07–1.55).
Why it matters
This review demonstrates that the adverse effects of endometriosis and adenomyosis extend beyond impaired conception into late pregnancy and delivery complications. The findings indicate that affected women should receive specialized prenatal counseling and be managed as higher-risk obstetric patients.
Limits
The review relies on observational and comparative study designs, which are subject to residual confounding. The total number of patients across the 104 included studies was not reported in the abstract. Subtype-specific conclusions were constrained by inconsistent reporting in primary literature, and long-term offspring outcomes were not evaluated.
Cited by
- supports Endometriosis and associated pelvic inflammation increase the risk of ectopic pregnancy and miscarriage.