Impact of ovarian endometrioma on the ovarian reserve

Abstract

Objective To evaluate the impact of ovarian endometrioma without surgery on patients’ ovarian reserve and clinical pregnancy outcomes after control ovarian hypersimulation. Methods A total of 352 patients were included, who were performed the first cycle of in vitro fertilization or intracytoplasmic sperm injection (IVF/ICSI) followed by fresh embryo transfer in Sun Yat-Sen Memorial Hospital Sun Yat-Sen University Reproductive Medicine Center between January 2011 and October 2017. The 176 patients with ovarian endometrioma without surgery treatment were classified into ovarian endometrioma group; meanwhile the other 176 cases with male factor infertility matched with age were classified into control group. The ovarian endometrioma group was further divided into unilateral endometrioma subgroup (n=146) and bilateral endometrioma subgroup (n=30). According to the average diameter of the endometrioma, the ovarian endometrioma group was divided into two subgroups: <3 cm group and≥3 cm group. The serum antral follicle count (AFC), anti-Mullerian hormone (AMH), and the number of oocytes retrieved and pregnancy outcomes after assisted reproductive technology (ART) were compared between the groups. The AFC and number of oocytes retrieved from the endometrioma-containing ovary and the opposite ovary were also compared in patients with unilateral ovarian endometrioma. Results The AFC and AMH were significantly lower in ovarian endometrioma group [5.7±3.8, (3.32±2.71) μg/L] than in control group [8.1±4.3, P 0.05). The AFC was significantly lower in patients with bilateral endometrioma (4.8±3.2) than that in patients with unilateral endometrioma (5.9±3.4, P=0.05), but no differences have been found in terms of AMH, the number of oocytes retrieved, and high-quality embryo rate (P>0.05). Embryo implantation rate and clinical pregnancy rate in unilateral group (34.54%, 57.63%) were higher than those in bilateral group (22.22%, 26.36%), but without statistical significances (P>0.05). In the patients with unilateral ovarian endometrioma, the AFC and AMH were both lower in the endometrioma-containing ovary (5.0±3.6, 4.2±3.3) than in the opposite ovary (6.5±4.0, P<0.001; 4.8±3.7, P=0.030). In the patients with different diameter of ovarian endometrioma, the high-quality embryo rate of the group with a diameter≥3 cm (33.82%) was significantly lower than that of the group with a diameter <3 cm (26.85%, P=0.031). Conclusion The ovarian endometrioma without surgery treatment itself could damage the ovarian reserve and reduce the ovarian response to controlled hyperstimulation, but has no impact on the pregnancy outcomes of patients with ovarian endometrioma. Key words: Ovarian endometrioma; Ovarian reserve; Pregnancy outcomes; Assisted reproductive technology