Interventions for endometriosis-related infertility: a systematic review and network meta-analysis

Objective: To compare the effectiveness of different treatments for women with endometriosis-related infertility. Design: A systematic review and network meta-analysis of randomized controlled trials (RCTs). Setting: Not applicable. Patient(s): Women with endometriosis confirmed by laparoscopy with associated infertility. Intervention(s): An extensive electronic search of the following databases: Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, ClinicalTrials.gov, and Embase. Main Outcome Measure(s): Clinical pregnancy, live birth rate, miscarriage, and adverse events. Result(s): A total of 4,252 trials/abstracts were identified through the literature search, of which we included 36 trials in the systematic review and 26 trials reporting on 2,245 women with endometriosis-related infertility in the network meta-analysis. Network metaanalysis showed that compared with placebo, surgical laparoscopy alone (odds ratio = 1.63; 95% confidence interval, 1.13-2.35) or GnRH agonist alone (odds ratio = 1.68; 95% confidence interval, 1.07-2.46) results in higher odds of pregnancy. The evidence on the other interventions versus placebo or on the secondary outcomes including live birth, miscarriage, and adverse events is insufficient. Conclusion(s): The most important conclusion is that more RCTs are needed to clarify the relative effectiveness of treatments for endometriosis-related infertility, ideally comparing interventions to existing recommended interventions such as surgical laparoscopy. In addition, further RCTs comparing IVF and IUI to other treatments are essential. (C) 2019 by American Society for Reproductive Medicine.