Advanced endometriosis - how can fertility treatment outcomes be optimised and when should fertility preservation be offered?

Research problem and specific questions:Is early surgery before IVF a potential game-changer in improving reproductive outcomes for women with advanced endometriosis?Mild versus severe forms of endometriosis - what specific risks and complications must be considered in fertility treatments, pregnancies, and childbirth?Fertility preservation measures in severe endometriosis - when, how, and for whom?Data and method:Study 1: National RCT.

Patients with endometriosis stage III-IV referred for IVF treatment will be randomized to receive either primary endometriosis surgery followed by IVF (intervention) or primary IVF alone. Primary outcomes include clinical pregnancy rate and live birth rate within two years from randomization.

Secondary outcomes include cumulative pregnancy rate, cumulative live birth rate, miscarriage rate, post-egg retrieval infections, as well as quality of life and pain before IVF, at the time of egg retrieval, and two months after IVF.Study 2: National register study including all women diagnosed with endometriosis during surgery.

National registry data on the severity of endometriosis will be utilized, and reproductive and perinatal outcomes among women with milder versus severe forms of endometriosis will be compared.

Study 3: National cohort study aiming to investigate the effectiveness and safety of fertility preservation measures in moderate/severe endometriosis.

Data will be collected from fertility clinics at all university hospitals in Sweden regarding women who underwent fertility preservation due to endometriosis and subsequently returned to use their frozen eggs or embryos.Societal relevance and impact: The project aims to improve the chances of pregnancy/preserved fertility in women with severe endometriosis, and reduce the risk of complications in fertility treatments, pregnancies, and childbirth in this patient group.

This has both individual and societal significance, including reducing the socioeconomic burden on healthcare systems and facilitating the formulation of uniform treatment guidelines and knowledge dissemination.Implementation: In a strong research group with expertise including surgery for advanced endometriosis and highly specialized IVF treatments, epidemiology, and statistics.

Well-established collaborative structure among different clinics in the country.