Endometriosis, especially mild disease: a risk factor for miscarriages.

Kohl Schwartz, Alexandra; Wölfler, Monika Martina; Mitter, Vera; Rauchfuss, Martina; Haeberlin, Felix; Eberhard, Markus; von Orelli, Stephanie; Imthurn, Bruno; Imesch, Patrick; Fink, Daniel; Leeners, Brigitte (2017). Endometriosis, especially mild disease: a risk factor for miscarriages. Fertility and sterility, 108(5), 806-814.e2. Elsevier 10.1016/j.fertnstert.2017.08.025

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OBJECTIVE To investigate the prevalence of miscarriage in women with endometriosis (WwE) compared with disease-free control women (CW). DESIGN Cross-sectional analysis nested in a retrospective observational study (n = 940). SETTING Hospitals and associated private practices. PATIENT(S) Previously pregnant women (n = 268) within reproductive age in matched pairs. INTERVENTION(S) Retrospective analysis of surgical reports and self-administered questionnaires. MAIN OUTCOME MEASURE(S) Rate of miscarriage, subanalysis for fertility status (≤12 vs. >12 months' time to conception), endometriosis stages (revised American Society of Reproductive Medicine classification [rASRM] I/II vs. III/IV) and phenotypic localizations (superficial peritoneal, ovarian, and deep infiltrating endometriosis). RESULT(S) The miscarriage rate was higher in WwE (35.8% [95% confidence interval 29.6%-42.0%]) compared with CW (22.0% [16.7%-27.0%]); adjusted incidence risk ratio of 1.97 (95% CI 1.41-2.75). This remained significant in subfertile WwE (50.0% [40.7%-59.4%]) vs. CW (25.8% [8.5%-41.2%]) but not in fertile WwE (24.5% [16.3%-31.6%]) vs. CW (21.5% [15.9%-26.8%]). The miscarriage rate was higher in women with milder forms (rASRM I/II 42.1% [32.6%-51.4%] vs. rASRM III/IV 30.8% [22.6%-38.7%], compared with 22.0% [16.7%-27.0%] in CW), and in women with superficial peritoneal endometriosis (42.0% [32.0%-53.9%]) compared with ovarian endometriosis (28.6% [17.7%-38.7%]) and deep infiltrating endometriosis (33.9% [21.2%-46.0%]) compared with CW (22.0% [16.7%-27.0%]). CONCLUSION(S) Mild endometriosis, as in superficial lesions, is related to a great extent of inflammatory disorder, possibly leading to defective folliculogenesis, fertilization, and/or implantation, presenting as increased risk of miscarriage. CLINICAL TRIAL REGISTRATION NUMBER NCT02511626.

Item Type:

Journal Article (Original Article)


04 Faculty of Medicine > Department of Gynaecology, Paediatrics and Endocrinology (DFKE) > Clinic of Gynaecology

UniBE Contributor:

Kohl Schwartz, Alexandra


600 Technology > 610 Medicine & health








Monika Zehr

Date Deposited:

11 Jun 2018 15:47

Last Modified:

18 May 2020 13:47

Publisher DOI:


PubMed ID:


Uncontrolled Keywords:

Endometriosis infertility miscarriage pregnancy outcome superficial peritoneal endometriosis





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