IVF in endometriosis: emerging evidence of exacerbation of pelvic pain and potential predictors.

study questionDoes IVF worsen pelvic pain in women with endometriosis? SUMMARY ANSWER: Nearly half of women with endometriosis reported perceived worsening of pelvic pain after IVF. WHAT IS KNOWN ALREADY: Prior studies generally suggested no IVF-related pain worsening, but few assessed delayed flares or longer-term trajectories. STUDY DESIGN SIZE DURATION: International cross-sectional study based on an online survey conducted between September 2024 and April 2025 including 546 respondents. PARTICIPANTS/MATERIALS SETTING

methodsWomen aged ≥18 years with surgically or imaging-confirmed endometriosis and at least one completed IVF cycle. A 25-item questionnaire captured demographics, reproductive history, comorbidities, and patient-reported pain trajectories before, during, and after IVF. The primary outcome was perceived worsening of pelvic pain after IVF (patient-reported outcome measure; PROM). Secondary outcomes were worsening of dysmenorrhoea and dyspareunia. Group comparisons and exploratory multivariable logistic regressions were performed. Predictor analyses were exploratory. MAIN RESULTS AND THE ROLE OF CHANCE: Among 546 respondents, 48.9% reported worsening pelvic pain after IVF, 49.1% reported worsening dysmenorrhoea, and 35.5% worsening dyspareunia. Current pain scores were significantly higher in women reporting worsening versus no worsening (all LIMITATIONS REASONS FOR CAUTION: Self-reported, retrospective data are prone to recall and selection bias, and the cross-sectional design precludes causal inference. Recruitment via associations and social media without a denominator limits generalizability, absence of baseline pain scores impedes assessment of change, and incomplete capture of peri-IVF hormonal regimens may confound results. WIDER IMPLICATIONS OF THE

findingsIVF may not be pain-neutral in endometriosis. Monitoring pain trajectories at key IVF milestones may help identify women at risk of long-term exacerbation. Prospective studies should test whether early monitoring combined with tailored interventions-optimized analgesia, psychological support, or adapted stimulation protocols-can mitigate chronic pain trajectories throughout the IVF journey and ultimately improve quality of life. STUDY FUNDING/COMPETING INTERESTS: No specific funding; authors declare no conflicts of interest. TRIAL REGISTRATION NUMBER: N/A.