STUDY QUESTION Do the outcomes and use of ART differ between women with and without endometriosis? SUMMARY ANSWER ART use and outcome do not appear to differ for women with and without endometriosis, as long as endometriosis is diagnosed prior to commencing ART. WHAT IS KNOWN ALREADY Approximately 40% of women with endometriosis have infertility and ART is the recommended treatment option for these women. However, diagnosis of endometriosis can be complex and lengthy, and a delay in diagnosis can reduce the likelihood of achieving a live birth. STUDY DESIGN, SIZE, DURATION This retrospective national cohort study used longitudinal self-report data (collected 1996–2018) from women born in 1973–1978 who are participants in the Australian Longitudinal Study on Women’s Health (ALSWH). The study also used linked administrative data on Endometriosis (1970–2018), ART (1996–2020) and births (1996–2018). PARTICIPANTS/MATERIALS, SETTING, METHODS The outcome measures were: age at first ART cycle; use of ART treatments (IVF only; IUI only/and IVF); number of ART cycles (1–3; 4–10; 11–36); and births after first ART (no; yes) (note that births could not be tied to ART). MAIN RESULTS AND THE ROLE OF CHANCE One in three (34.7%, n = 459/1322) women using ART had endometriosis, with 65.6% of these diagnosed before first ART and 34.4% after. Adjusted regression analyses showed women with endometriosis diagnosed before first ART were not significantly different to women without endometriosis on any outcome. However, women with endometriosis diagnosed after first ART were more likely to use IUI (adjusted odds ratio (aOR) 2.14, 95% CI 1.48, 3.09) and do more cycles (11–36 cycles: aOR 4.09, 95% CI 2.41, 6.95), and less likely to report a birth (aOR 0.67, 95% CI 0.45, 0.99), compared to women without endometriosis, despite no significant difference in starting age (coefficient = −0.62, 95% CI −1.36, 0.13). LIMITATIONS, REASONS FOR CAUTION We did not have information on the severity of endometriosis, or the reasons for using ART, which can influence treatment and outcomes. We were not able to reliably link births with ART treatment. Finally, it is possible that some of the women in our ‘no endometriosis’ group did have endometriosis and were unaware of it, although prevalence rates match population estimates. WIDER IMPLICATIONS OF THE FINDINGS These findings support previous studies that have found no difference in outcome of ART for women with endometriosis, but add the new insight that this is only true if endometriosis is diagnosed prior to commencing ART. A delayed diagnosis can create disadvantage during ART treatment. Early recourse to IVF may be advantageous for pregnancy prospects for women with endometriosis. STUDY FUNDING/COMPETING INTEREST(S) The ALSWH is funded by the Australian Government Department of Health. G.D.M. is supported by an NHMRC Principal Research Fellowship (APP11218449). The authors have no conflicts of interest to declare. TRIAL REGISTRATION NUMBER N/A.

中文翻译：

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子宫内膜异位症的延迟诊断对 ART 中的女性不利：一项回顾性人群关联数据研究

研究问题 ART 的结果和使用在患有和不患有子宫内膜异位症的女性之间是否存在差异？总结 答案 只要在开始 ART 之前诊断出子宫内膜异位症，对于患有和不患有子宫内膜异位症的女性，ART 的使用和结果似乎没有差异。已知情况 大约 40% 的子宫内膜异位症女性患有不孕症，而 ART 是这些女性的推荐治疗选择。然而，子宫内膜异位症的诊断可能复杂而冗长，延迟诊断会降低活产的可能性。研究设 该研究还使用了子宫内膜异位症（1970-2018）、ART（1996-2020）和出生（1996-2018）的相关行政数据。参与者/材料、设置、方法 结果测量是：第一个 ART 周期的年龄；使用 ART 治疗（仅限 IVF；仅限 IUI/和 IVF）；ART 周期数（1-3；4-10；11-36）；和第一次 ART 后的分娩（否；是）（请注意，分娩不能与 ART 挂钩）。主要结果和机会的作用 三分之一 (34.7%, n = 459/1322) 使用 ART 的女性患有子宫内膜异位症，其中 65.6% 在第一次 ART 之前被诊断出来，34.4% 在之后被诊断出来。调整后的回归分析显示，在第一次 ART 之前诊断出患有子宫内膜异位症的女性与没有子宫内膜异位症的女性在任何结果上都没有显着差异。然而，第一次 ART 后诊断为子宫内膜异位症的女性更有可能使用 IUI（调整优势比 (aOR) 2.14, 95% CI 1.48, 3. 09）和做更多周期（11-36 个周期：aOR 4.09, 95% CI 2.41, 6.95），与没有子宫内膜异位症的女性相比，报告分娩的可能性更低（aOR 0.67, 95% CI 0.45, 0.99），尽管没有起始年龄的显着差异（系数 = -0.62, 95% CI -1.36, 0.13）。限制、谨慎的原因 我们没有关于子宫内膜异位症严重程度或使用 ART 的原因的信息，这会影响治疗和结果。我们无法可靠地将分娩与 ART 治疗联系起来。最后，我们的“无子宫内膜异位症”组中的一些女性可能确实患有子宫内膜异位症并且没有意识到这一点，尽管患病率与人口估计相符。研究结果的更广泛意义 这些研究结果支持了先前的研究，这些研究发现 ART 对子宫内膜异位症女性的结果没有差异，但增加了新的见解，即只有在开始 ART 之前诊断出子宫内膜异位症时，这才是正确的。延迟诊断可能会在 ART 治疗期间造成不利影响。早期使用体外受精可能有利于子宫内膜异位症女性的怀孕前景。学习资金/竞争兴趣 ALSWH 由澳大利亚政府卫生部资助。GDM 得到 NHMRC 首席研究奖学金 (APP11218449) 的支持。作者没有需要声明的利益冲突。试用注册号 不适用。学习资金/竞争兴趣 ALSWH 由澳大利亚政府卫生部资助。GDM 得到 NHMRC 首席研究奖学金 (APP11218449) 的支持。作者没有需要声明的利益冲突。试用注册号 不适用。学习资金/竞争兴趣 ALSWH 由澳大利亚政府卫生部资助。GDM 得到 NHMRC 首席研究奖学金 (APP11218449) 的支持。作者没有需要声明的利益冲突。试用注册号 不适用。