Semin Reprod Med 2000; 18(4): 363-368
DOI: 10.1055/s-2000-13726
Copyright © 2000 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Endometriosis and Recurrent Pregnancy Loss

Ellen E. Vercammen, Thomas M. D'Hooghe
  • Leuven University Fertility Center, Department of Obstetrics & Gynecology, University Hospital Gasthuisberg, Leuven, Belgium
Further Information

Publication History

Publication Date:
31 December 2000 (online)


A possible association between endometriosis and spontaneous abortion has been suggested in mostly uncontrolled and/or retrospective studies. Some controlled studies evaluating the association between endometriosis and spontaneous abortion showed important methodological shortcomings: heterogeneity between cases and controls, analysis of the abortion rate before the diagnosis of endometriosis, and selection bias of study and control groups. On the basis of controlled prospective studies, there is no evidence that endometriosis is associated with (recurrent) pregnancy loss or that medical or surgical treatment of endometriosis reduces the spontaneous abortion rate. In programs of assisted reproduction, some studies have shown that the number and quality of oocytes, the fertilization rate, and the implantation rate per embryo may be reduced in women with endometriosis, but this observation has not been confirmed by other investigators. Future studies evaluating the reproductive outcome of patients with endometriosis in assisted reproduction programs should include reliable information about the date and histological confirmation of the diagnosis of endometriosis, time interval between treatment with assisted reproduction and the last laparoscopy, possible recurrence of endometriosis, effectiveness of interim hormonal (suppressive) therapy, accuracy of ultrasound diagnosis, and accuracy of ``negative'' diagnosis.


  • 1 Hill J A. Recurrent spontaneous early pregnancy loss. In: Berek JS, Adashi EY, Hillard PA, eds. Novak's Gynecology 12th ed. Baltimore: Williams & Wilkins 1997: 963-979
  • 2 Boué J, Boué A, Laser P. Restrospective and prospective epidemiologic studies of 1500 karyotyped spontaneous abortions.  Teratology . 1975;  11 11-26
  • 3 Stein Z. Early fetal loss.  Birth Defects . 1981;  17 95-111
  • 4 Naples J D, Batt R E, Sadigh H. Spontaneous abortion rate in patients with endometriosis.  Obstet Gynecol . 1981;  57 509-512
  • 5 Wheeler J M, Johnston B M, Malinak L R. The relationship of endometriosis to spontaneous abortion.  Fertil Steril . 1983;  39 656-660
  • 6 Groll M. Endometriosis and spontaneous abortion.  Fertil Steril . 1984;  44 933-935
  • 7 FitzSimmons J, Stahl R, Gocial B, Shapiro S S. Spontaneous abortion and endometriosis.  Fertil Steril . 1987;  47 696-698
  • 8 Pittaway D E, Vernon C, Fayez J A. Spontaneous abortions in women with endometriosis.  Fertil Steril . 1988;  50 711-715
  • 9 Candiani G B, Danesino V, Gastaldi A, Parazzini F, Ferraroni M. Reproductive and menstrual factors and risk of peritoneal and ovarian endometriosis.  Fertil Steril . 1991;  56 230-234
  • 10 Matorras R, Rodriguez F, Gutierrez de Teran G, Pijoan J I, Ramon O, Rodriguez-Escudero F J. Endometriosis and spontaneous abortion rate: a cohort study in infertile women.  Eur J Obstet Gynecol Reprod Biol . 1998;  77 101-105
  • 11 Metzger D A, Olive D L, Stobs G F, Franklin R R. Association of endometriosis and spontaneous abortion: effect of control group selection.  Fertil Steril . 1986;  45 18-22
  • 12 Marcoux S, Maheux R, Bérubé S, and the Canadian Collaborative Group on Endometriosis. Laparoscopic surgery in infertile women with minimal or mild endometriosis.  N Engl J Med . 1997;  337 217-222
  • 13 Gruppo ltaliano per lo Studio dell'Endometriosi. Ablations of lesions or no treatment in minimal-mild endometriosis in infertile women: a randomized trial.  Hum Reprod . 1999;  14 1332-1334
  • 14 Pittaway D E, Ellington C P, Klimek M. Preclinical abortions and endometriosis.  Fertil Steril . 1988;  49 221-223
  • 15 Regan L, Braude P R, Trembath P L. Influence of post reproductive performance on risk of spontaneous abortion.  BMJ . 1989;  299 541-545
  • 16 American Fertility Society. Revised American Fertility Society classification of endometriosis: 1985.  Fertil Steril . 1985;  43 351-352
  • 17 Moen M H, Halvorsen T B. Histologic confirmation of endometriosis in different peritoneal lesions.  Acta Obstet Gynecol Scand . 1992;  71 337-342
  • 18 Balasch J, Creus M, Vanrell J A. Lack of endometriosis in patients with repeated abortion.  Hum Reprod . 1988;  3 263-264
  • 19 Acosta A A, Buttram Jr C V, Besch B K, Malinak L R, Franklin R R, Vanderheyden C T. A proposed classification of pelvic endometriosis.  Obstet Gynecol . 1973;  42 19
  • 20 D'Hooghe T M, Hill J A. Endometriosis. In: Novak's Gynecology, 12th ed. Baltimore: Williams & Wilkins; 12th edition. 1997: 887-920
  • 21 Arici A, Oral E, Bukulmez O, Duleba A, Olive D L, Jones E E. The effect of endometriosis on implantation: results from the Yale University in vitro fertilization and embryo transfer program.  Fertil Steril . 1996;  65 603-607
  • 22 Simon C, Guttierez A, Vidal A. Outcome of patients with endometriosis in assisted reproduction: results from in-vitro fertilization and oocyte donation.  Hum Reprod . 1994;  9 725-729
  • 23 Pellicer A, Albert C, Mercader A, Bonilla-Musoles F, Remohi J, Simon C. The follicular and endocrine environment in women with endometriosis: local and systemic cytokine production.  Fertil Steril . 1998;  70 425-431
  • 24 Minguez Y, Rubio C, Bernal A. The impact of endometriosis in couples undergoing intracytoplasmic sperm injection.  Hum Reprod . 1997;  12 2282-2285