Endometriosis-related infertility: assisted reproductive technology has no adverse impact on pain or quality-of-life scores

Pietro Santulli; Mathilde Bourdon; Marion Presse; Vanessa Gayet; Louis Marcellin; Caroline Prunet; Dominique de Ziegler; Charles Chapron

doi:10.1016/j.fertnstert.2015.12.006

Endometriosis-related infertility: assisted reproductive technology has no adverse impact on pain or quality-of-life scores

Fertil Steril. 2016 Apr;105(4):978-987.e4. doi: 10.1016/j.fertnstert.2015.12.006. Epub 2015 Dec 30.

Authors

Pietro Santulli¹, Mathilde Bourdon², Marion Presse², Vanessa Gayet², Louis Marcellin³, Caroline Prunet⁴, Dominique de Ziegler², Charles Chapron⁵

Affiliations

¹ Department of Gynaecology Obstetrics II and Reproductive Medicine, Faculté de Médecine, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre, Centre Hospitalier Universitaire (CHU) Cochin, Université Paris Descartes, Sorbonne Paris Cité, Paris, France; Laboratoire d'Immunologie, Institut Cochin, Inserm, U1016, Université Paris Descartes, Sorbonne Paris Cité, Paris, France. Electronic address: pietro.santulli@cch.aphp.fr.
² Department of Gynaecology Obstetrics II and Reproductive Medicine, Faculté de Médecine, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre, Centre Hospitalier Universitaire (CHU) Cochin, Université Paris Descartes, Sorbonne Paris Cité, Paris, France.
³ Department of Gynaecology Obstetrics II and Reproductive Medicine, Faculté de Médecine, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre, Centre Hospitalier Universitaire (CHU) Cochin, Université Paris Descartes, Sorbonne Paris Cité, Paris, France; Laboratoire d'Immunologie, Institut Cochin, Inserm, U1016, Université Paris Descartes, Sorbonne Paris Cité, Paris, France; Département de Génetique, Développement et Cancer, Institut Cochin, Inserm, U1016, Université Paris Descartes, Sorbonne Paris Cité, Paris, France.
⁴ Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Center for Epidemiology and Biostatistics, Institut Cochin, Inserm U1153, Paris, France.
⁵ Department of Gynaecology Obstetrics II and Reproductive Medicine, Faculté de Médecine, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre, Centre Hospitalier Universitaire (CHU) Cochin, Université Paris Descartes, Sorbonne Paris Cité, Paris, France; Département de Génetique, Développement et Cancer, Institut Cochin, Inserm, U1016, Université Paris Descartes, Sorbonne Paris Cité, Paris, France.

PMID: 26746132
DOI: 10.1016/j.fertnstert.2015.12.006

Abstract

Objective: To evaluate the impact of assisted reproduction technology (ART) on painful symptoms and quality of life (QoL) in women who have endometriosis as compared with disease-free women.

Design: Prospective controlled, observational cohort study.

Setting: University hospital.

Patient(s): Two hundred and sixty-four matched-pairs of endometriosis and disease-free women undergoing ART.

Intervention(s): Assessment of pain evolution using visual analogue scale (VAS) during ART; QoL assessment with the Fertility Quality of Life (FertiQoL) tool.

Main outcome measure(s): VAS pain intensities relative to dysmenorrhea, dyspareunia, noncyclic chronic pelvic pain (NCCPP), gastrointestinal pain, lower urinary tract pain; trends for VAS change between postretrieval and baseline evaluation; FertiQoL score; and statistical analyses conducted using univariate and adjusted multiple linear regression models.

Result(s): After excluding canceled cycles and patients lost to follow-up observation, 102 women with endometriosis and 104 disease-free women were retained for the study. The trends for VAS change between the postretrieval and baseline evaluations in the women with endometriosis compared with the disease-free women revealed a statistically significant pain decrease for dysmenorrhea (-1.35 ± 3.23 and 0.61 ± 4.00) and dyspareunia (-1.19 ± 2.58 and 0.14 ± 2.06). For NCCPP, gastrointestinal symptoms, and lower urinary tract symptoms, there were no statistically significant differences between the groups. After multiple linear regression, no worsening of pain was observed in the endometriosis group as compared with disease-free group. In addition subgroup analysis according to endometriosis phenotype failed to show any increase of pain. The quality of life in the endometriosis group was comparable to that of the disease-free group.

Conclusion(s): Assisted reproduction technology did not exacerbate the symptoms of endometriosis or negatively impact QoL in women with endometriosis as compared with disease-free women.

Keywords: Endometriosis; IVF; pain; quality of life.

Publication types

Observational Study

MeSH terms

Adult
Cohort Studies
Endometriosis / diagnosis*
Endometriosis / epidemiology*
Endometriosis / psychology
Female
Follow-Up Studies
Humans
Infertility, Female / diagnosis
Infertility, Female / epidemiology
Infertility, Female / psychology
Pain Measurement / psychology
Pain Measurement / trends*
Pelvic Pain / diagnosis
Pelvic Pain / epidemiology
Prospective Studies
Quality of Life* / psychology
Reproductive Techniques, Assisted / psychology
Reproductive Techniques, Assisted / trends*