Influence of endometriosis on the outcomes of assisted reproductive technology in poor ovarian responders with previous implantation failures

Objective: To evaluate whether endometriosis (EMS) adversely affects the embryological and clinical outcomes of assisted reproductive technology (ART) in poor ovarian responders (PORs) with repeated implantation failure undergoing spindle view-assisted intracytoplasmic sperm injection (SV-ICSI). Methods: This retrospective study included women aged 35-44 years who underwent ART with SV-ICSI at a single fertility center between January 2023 and December 2024. All participants fulfilled the Bologna criteria for POR and had experienced at least three previous failed embryo transfer cycles. Patients with laparoscopically confirmed EMS were assigned to the EMS group (n=36), whereas age-matched patients without a history or ultrasonographic evidence of EMS were selected as controls in a 1:3 ratio (n=108). Results: The baseline characteristics were comparable between the two groups. No significant differences were observed between the EMS and control groups in key embryological parameters including fertilization rate, cleavage rate, good-quality cleavage embryo rate, and blastocyst formation rate. Similarly, ART-related clinical outcomes did not differ significantly between the two groups, including implantation rate (13.0% vs. 11.7%), clinical pregnancy rate (19.4% vs. 18.5%), and clinical abortion rate (28.6% vs. 40.0%). Conclusion: In this retrospective cohort of patients with POR with repeated implantation failure, no statistically significant association was found between EMS and embryological or ART-related clinical outcomes. However, given the limited sample size and reliance on surrogate reproductive endpoints, these findings should be considered preliminary and hypothesis generating and require confirmation in larger prospective studies incorporating live birth outcomes.