Endometriosis, especially mild disease: a risk factor for miscarriages

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.