Alexandra Sabrina Kohl Schwartz1, Monika Martina Wölfler2, Vera Mitter3, Martina Rauchfuss4, Felix Haeberlin5, Markus Eberhard6, Stephanie von Orelli7, Bruno Imthurn8, Patrick Imesch9, Daniel Fink9, Brigitte Leeners8. 1. 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. 2. Division of Gynecological Endocrinology and Reproductive Medicine, Medical University of Graz, Graz, Austria; Department of Obstetrics and Gynecology, RWTH Aachen University Hospital, Aachen, Germany. 3. Division of Gynecological Endocrinology and Reproductive Medicine, Bern University Hospital, University of Bern, Bern, Switzerland. 4. Department of Psychosomatics, Charité University Hospital Berlin, Berlin, Germany. 5. Women's Hospital, Cantonal Hospital St. Gallen, St. Gallen, Switzerland. 6. Women's Hospital, Cantonal Hospital Schaffhausen, Schaffhausen, Switzerland. 7. Maternité, Stadtspital Triemli, Zurich, Switzerland. 8. Department of Reproductive Endocrinology, University Hospital Zurich, Zurich, Switzerland. 9. Department of Gynecology, University Hospital Zurich, Zurich, Switzerland.
Abstract
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.
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.
Authors: Creighton E Likes; Leah J Cooper; Jessica Efird; David A Forstein; Paul B Miller; Ricardo Savaris; Bruce A Lessey Journal: J Assist Reprod Genet Date: 2019-01-04 Impact factor: 3.412
Authors: Francisco Álvarez-Salvago; Ana Lara-Ramos; Irene Cantarero-Villanueva; Maryna Mazheika; Antonio Mundo-López; Noelia Galiano-Castillo; Carolina Fernández-Lao; Manuel Arroyo-Morales; Olga Ocón-Hernández; Francisco Artacho-Cordón Journal: Int J Environ Res Public Health Date: 2020-05-21 Impact factor: 3.390
Authors: Ilona Lukas; Alexandra Kohl-Schwartz; Kirsten Geraedts; Martina Rauchfuss; Monika M Wölfler; Felix Häberlin; Stephanie von Orelli; Markus Eberhard; Bruno Imthurn; Patrick Imesch; Brigitte Leeners Journal: PLoS One Date: 2018-11-29 Impact factor: 3.240
Authors: Marita Lina Sperschneider; Michael P Hengartner; Alexandra Kohl-Schwartz; Kirsten Geraedts; Martina Rauchfuss; Monika Martina Woelfler; Felix Haeberlin; Stephanie von Orelli; Markus Eberhard; Franziska Maurer; Bruno Imthurn; Patrick Imesch; Brigitte Leeners Journal: BMJ Open Date: 2019-01-09 Impact factor: 2.692