Abstract
PurposeTo determine the impact of ovarian endometrioma per se on in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) outcomes.MethodsThis retrospective study was conducted using two groups. The endometrioma group consisted of 862 women with infertility who had ovarian endometriomas and underwent their first ovarian stimulation for IVF/ICSI treatment between January 2011 to December 2019 at a public university hospital. A non-endometrioma comparison group, comprising 862 women with other infertility factors, was matched according to maternal age, body mass index (BMI), and infertility duration. Ovarian reserve and response and IVF/ICSI and pregnancy outcomes between the two groups were analyzed. Multivariate logistic regression (MLR) analysis was conducted on the basis of clinical covariates assessed for their association with live birth.ResultsThe results showed that significantly lower antral follicle count (AFC), anti-Müllerian hormone (AMH), ovarian sensitivity index (OSI), oocyte maturation and fertilization rates, blastocyst rate, number of oocytes retrieved, and available embryos were found in women with endometrioma compared with the control, respectively (P < 0.05). The cumulative live birth rate per patient in women with endometrioma was lower than that of women without endometrioma (39.32% vs. 46.87%, P = 0.002). In women with endometrioma, those who underwent surgical intervention prior to IVF/ICSI treatment had higher maturation (86.03% vs. 83.42%, P = 0.003), fertilization (78.16% vs. 74.93%, P = 0.004), and top-quality embryo rates (42.94% vs. 39.93%, P = 0.097) but had fewer oocytes retrieved (8.01 ± 5.70 vs. 9.12 ± 6.69, P = 0.013) than women without surgery. However, live birth rates were comparable between women with endometrioma and women in the control group, regardless of whether they had a prior history of ovarian surgery. MLR analysis showed no correlation between endometrioma per se and live birth after being adjusted for number of top-quality embryos transferred and stage of embryo transfer.ConclusionsThe data from this study supported the conclusion that ovarian endometrioma negatively impacts oocyte quality and quantity, but not overall pregnancy outcomes, in women undergoing IVF/ICSI treatment. Endometrioma lowers the cumulative live birth rate by decreasing the number of embryos. Surgical excision of endometrioma prior to IVF/ICSI can partly improve oocyte maturation and fertilization rates but not pregnancy outcomes.
Highlights
Endometriosis (EMS) is a common, benign disease characterized by the histological presence of functional endometrial glands or stroma outside the uterine cavity, affecting about 50% of infertile women [1]
Pregnancy results after in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) treatment were not improved in women with surgical treatment of endometriomas smaller than 6 cm compared to the women who refused operation [15]
No significant differences were observed between the two groups in regard to age, body mass index (BMI), and infertility duration, showing a valid matching in the enrolled population
Summary
Endometriosis (EMS) is a common, benign disease characterized by the histological presence of functional endometrial glands or stroma outside the uterine cavity, affecting about 50% of infertile women [1]. Ovarian endometrioma is one of the most common forms of EMS, present in up to 30%–40% of women with EMS [1]. This condition is characterized by the presence of one or more cysts stemming from endometrial tissue that is histologically and functionally similar to eutopic endometrium [2]. Other studies have revealed that local inflammation and toxic content such as free iron diffusing from the endometrioma cyst into nearby ovarian tissue result in oocyte loss and poor embryo quality [5,6,7,8]. Some uncertainty remains regarding the benefits of surgery to remove cysts before pregnancy
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