Abstract
Some studies have shown that ICSI obtains poorer results than conventional IVF in women with ovarian endometriosis, suggesting that oocytes could be sensitive to ICSI-induced mechanical damage. The aims of this study were to clarify (a) whether ovarian endometriosis could induce peculiar fragility in the oocyte, so that ICSI would finally result harmful, and (b) whether endometrioma removal before IVF could be advisable in order to avoid any hypothetical detrimental effect. We retrospectively studied 368 women, 203 with in situ endometrioma (128 of which underwent ICSI, 75 conventional IVF) and 164 who received laparoscopic stripping of endometrioma before ICSI. For women with in situ endometrioma, cIVF and ICSI outcome was comparable for all parameters studied, including the clinical pregnancy rate per embryo transfer (PR/ET: 31.8% vs. 39.5% in the cIVF and ICSI groups) and cumulative live birth rate per ovum pick-up (CLBR/OPU: 24.4% vs. 27.7%). ICSI outcome was similar comparing women with in situ endometrioma and women previously submitted to laparoscopic stripping of cysts (CLPR/OPU 27.7% vs. 25.3%). Our findings suggest that (a) in women with in situ endometrioma ICSI may be performed, when needed, without harming oocytes and compromising the outcome and (b) that there is no advantage in removing endometrioma before ICSI.
Highlights
It was previously reported that the presence of an endometrioma could interfere with ovarian responsiveness to controlled ovarian stimulation (COS) and render oocyte retrieval more tricky and risky [1,2,3,4,5,6,7]
Checking our database, we found 203 women in which one or more ovarian endometriomas were present within the ovary at the time of IVF: some of them had a husband with severe dyspermia and were treated by ICSI (n = 128), whereas others had a non-male indication to IVF and underwent conventional IVF (cIVF) (n = 75)
Large studies comparing the results of cIVF and ICSI for the treatment of non-male factor infertility showed quite clearly that ICSI cannot offer any advantage in terms of clinical outcome [19,20,21]
Summary
It was previously reported that the presence of an endometrioma could interfere with ovarian responsiveness to controlled ovarian stimulation (COS) and render oocyte retrieval more tricky and risky [1,2,3,4,5,6,7]. 25–40, with ovarian endometriosis, showed that the fertilization rate was higher inseminating sibling oocytes by ICSI with normal semen than using cIVF, the ongoing pregnancy rate after ICSI was unusually low (15.6%), suggesting induced mechanical oocyte damage [11]. Recent research by Tan et al retrospectively compared the outcome of cIVF vs ICSI in women with endometriosis at various stages: patients with the disease at Stage 3 and 4 (including those with endometrioma) submitted to ICSI with normal semen obtained a significantly lower pregnancy and live birth rate than those undergoing cIVF [12], suggesting that the oocytes of these patients could be peculiarly fragile and could have been harmed by microinjection. The study by Tan et al excluded couples with a severe male factor, which are commonly found in the clinical practice and are “forced” to receive ICSI; as it is known that semen quality affects ICSI results [13], it could be argued that if ICSI would have been performed using pathological semen, the advantage of cIVF over ICSI could have resulted to be even higher
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