Predictors of clinical pregnancy after IVF in women with ovarian endometriomas: a propensity score-matched retrospective cohort study

Abstract Background Ovarian endometrioma (OMA) is associated with reduced in vitro fertilization (IVF) success rates. Therefore, the purpose of the study is to investigate risk factors associated with pregnancy outcomes following IVF in women with OMA and assess the predictive utility of maximum OMA diameter. Methods This propensity score-matched retrospective cohort study enrolled 2416 women who underwent IVF between December 2020 and November 2025. A total of 248 transvaginal ultrasound (TVUS)-confirmed OMA patients who underwent IVF were allocated to the OMA group. Conversely, 2,168 concurrently enrolled patients without ultrasonographically confirmed OMA who underwent IVF were assigned to the non-OMA group. A sample size of 738 was calculated to achieve a statistical power of 99.9% and a two-sided α of 0.05. Age, body mass index (BMI), and controlled ovarian hyperstimulation (COH) protocols were adjusted between the two groups using propensity score matching (PSM) at a 1:3 ratio. After PSM, 248 OMA patients were matched to 738 patients without OMA who underwent IVF. Additionally, 248 OMA patients were stratified into pregnant and non-pregnant groups according to clinical pregnancy outcome, and factors associated with clinical pregnancy among these patients were identified. Results After PSM, multivariate logistic regression revealed that type of infertility, number of abortions and cesarean deliveries, and level of sex hormones were independent factors for OMA, and OMA independently influenced clinical pregnancy and early abortion rates ( P < 0.05). In the OMA group, multivariate logistic regression identified age, abortion number, COH protocols, and maximum OMA diameter as independent predictors of clinical pregnancy outcomes. The integrated predictive model exhibited an area under the receiver operating characteristic curve (AUC) of 0.857, with optimal predicted cutoff values of 32.5 years for age and 21.25 mm for maximum OMA diameter. Conclusions The retrospective analysis delineated infertility type, obstetric history, and sex hormone profiles as independent risk factors for ovarian cysts. OMA subgroup analysis demonstrated age, abortion count, COH protocols, and maximum OMA diameter as key predictors of IVF outcomes. Registry The Ethics Review Committee of the Jiangsu Provincial Hospital of Traditional Chinese Medicine, approval number:2021NL-045-03, Registration date: 16 January 2021.