Women with Endometriosis have lower incidence of first live birth before diagnosis of disease

Finland: A recent study published in Human Reproduction found a lower incidence of first live birth in women before surgical verification of endometriosis compared to women who did not have endometriosis, regardless of the endometriosis type.

The study showed that endometriosis is linked to a reduction in fertility in the years preceding a definitive surgical diagnosis of the condition. The researchers suggest that the impairment of fertility among women with endometriosis should be minimized by offering relevant treatment for endometriosis without delay.

In the first study to look at birth rates in a large group of women who eventually received a surgical verification of endometriosis, researchers in Finland found that the number of first live births in the period before diagnosis was half that of women without the painful condition. This was the case regardless of what form of endometriosis the women had: ovarian, peritoneal, deep endometriosis or other types.

In addition, the researchers found evidence that the number of babies women had before endometriosis was diagnosed was significantly reduced compared to women who did not have endometriosis.live birth

Professor Oskari Heikinheimo of Helsinki University Hospital (Finland), who led the study, said: “Our findings suggest that doctors who see women suffering from painful menstruation and chronic pelvic pain, should keep in mind the possibility of endometriosis and treat them effectively. Doctors should discuss with these women the possible effects on their fertility and the effects of their age, and the impairment of fertility should be minimised by offering relevant treatment for endometriosis without delay.”

Endometriosis is a chronic inflammatory condition affecting up to 10% of women of child-bearing age. Tissue from the womb's lining grows in other places, such as the ovarian and fallopian tubes. Typical symptoms include painful menstruation, pain in the pelvic area, difficult or painful sexual intercourse, and difficulty getting pregnant. Correct diagnosis is often delayed by around seven years. Surgery has traditionally been the ‘gold standard’ for diagnosing the condition and classifying the type of endometriosis, although diagnosis by ultrasonographic findings or the symptoms alone is currently accepted.

Until now, there has been little information about the live birth rate among women with endometriosis, and little is known about the possible effects of different types of endometriosis on fertility, especially in the years before a diagnosis.

“Given the chronic nature and typical long delay in diagnosis of endometriosis, we wanted to find out if there were differences in first birth rates before diagnosis in a large group of women in the population,” said Prof. Heikinheimo.

He and his colleagues looked at 18,324 women in Finland, aged between 15 and 49 years, who had surgical verification of endometriosis between 1998 and 2012. They matched them with 35,793 women of similar age who did not have an endometriosis diagnosis. The follow-up period started at the age of 15 years and continued until the first live birth, sterilization, removal of the ovaries or womb, or until the surgical diagnosis of endometriosis, whichever came first. The women with endometriosis were also divided into four groups according to the type of endometriosis.

The average (mean) follow-up time before surgical diagnosis was 15.2 years. The average (median) age at the time of diagnosis of endometriosis was 35 years.

A total of 7,363 women (40%) with endometriosis and 23,718 women (66%) without endometriosis delivered a live-born baby during the follow-up period. The incidence rate of first live births among women with endometriosis was half that of women without the condition (0.51%). When analysed according to women’s birth decade from the 1940s to 1970s, the birth rate decreased in both groups of women. Importantly, over the decades, an increasingly lower first-live birth rate was seen in women with endometriosis than women without. In those women born in 1940-1949, the difference in live birth rates between the two groups was 28% before surgically diagnosed endometriosis, but this difference increased steadily to 87% by 1970-1979.

“We assume that this is associated with the older age of women when they have their first baby, earlier surgical diagnosis of endometriosis and accumulating adverse effects of endometriosis in women affected by the condition,” said Prof. Heikinheimo.

The number of children women had before their endometriosis was 1.93 and 2.16 for women without endometriosis.

“The possible effect of endometriosis on the desired number of children highlights the importance of early diagnosis and treatment of the disease,” he said.

He continued: “It is important to note that this study reports on live births before a definitive diagnosis of endometriosis. Next, we will report fertility rates after the surgical diagnosis and treatment of endometriosis. We hope that the fertility of women with endometriosis catches up with those without the condition after surgical management.”

Reference:

Anni Tuominen, Oskari Heikinheimo, Mika Gissler, Maarit Niinimäki, Päivi Härkki, Liisu Saavalainen, https://doi.org/10.1093/humrep/dead120.