Correlation Between Severity of Endometriosis and Infertility Outcomes: Relationship of rASRM Staging with Fertility Rates and Reproductive Outcomes: A Study of 100 Cases

Background: Endometriosis is a common chronic gynecological disorder and a well-recognized cause of female infertility. Although the revised American Society for Reproductive Medicine (rASRM) classification system is routinely used to stage endometriosis based on surgical findings, its ability to predict fertility outcomes remains controversial. Clarifying the relationship between disease severity and reproductive outcomes is essential for appropriate counseling and management of infertile women with endometriosis.

Objective: To evaluate the correlation between the severity of endometriosis, as classified by the rASRM staging system, and infertility outcomes, including spontaneous pregnancy rates, need for assisted reproductive technology (ART), ART success rates, and miscarriage rates.

Methods: This prospective observational study included 100 infertile women aged 20–40 years with laparoscopically confirmed endometriosis. Patients were classified intraoperatively into rASRM stages I–IV. All participants were followed for 24 months after surgery. Primary outcome was spontaneous conception, while secondary outcomes included requirement for ART, ART success rate (clinical pregnancy per cycle), and miscarriage rate. Statistical analysis was performed using chi-square tests, with p <0.05 considered significant.

Results: Among the study population, 22% had Stage I, 28% Stage II, 30% Stage III, and 20% Stage IV endometriosis. Spontaneous pregnancy rates declined significantly with increasing disease severity, from 45.5% in Stage I to 5.0% in Stage IV (p <0.001). The need for ART increased progressively across stages, affecting 27.3% of Stage I patients compared to 85.0% of Stage IV patients. ART success rates were highest in early-stage disease and significantly lower in advanced stages. Miscarriage rates increased with disease
severity, reaching 25.0% in Stage IV endometriosis.

Conclusion: The severity of endometriosis, as classified by rASRM staging, shows a significant inverse correlation with fertility outcomes. Early-stage endometriosis is associated with favorable reproductive prognosis, while moderate to severe disease predicts reduced spontaneous fertility, increased dependence on ART, lower ART success rates, and higher miscarriage risk. rASRM staging remains a valuable tool for fertility counseling and management planning in women with endometriosis.

Keywords: Endometriosis, Infertility, Rasrm Staging, Fertility Outcome, Assisted Reproductive Technology.