Ovarian response during IVF-embryo transfer cycles after laparoscopic ovarian cystectomy for endometriotic cysts of >3 cm in diameter.

Abstract

Ovarian response during IVF cycles after laparoscopic ovarian cystectomy for endometriotic cysts >3 cm is controversial. A retrospective study was designed to study this problem. At laparoscopy, endometriomas >3 cm were treated by ovarian cystectomy, whilst adhesions and peritoneal endometriosis were treated using conventional techniques. Ovarian stimulation was achieved with clomiphene and gonadotrophins or with gonadotrophins after a desensitization with gonadotrophin-releasing hormone agonists. Three groups of patients were retrospectively selected from an IVF-embryo transfer database: patients who underwent laparoscopic ovarian cystectomy for an endometrioma >3 cm (Group A, n = 41), patients with endometriosis without ovarian endometrioma (Group B, n = 139) and patients with tubal infertility (Group C, n = 59). The groups did not differ in age. In the first IVF cycle, the mean (+/- SD) numbers of oocytes and of embryos were 9.4 +/- 6.2 and 4.7 +/- 3.6 respectively in group A and 11.6 +/- 7.5 and 5.1 +/- 4.9 in group B (not significant). The results did not differ in cycles 2 and 3 or when compared according to age. No difference was found when comparing patients with endometriosis and patients with tubal infertility. The number of oocytes and embryos obtained was not significantly decreased by laparoscopic cystectomy, suggesting that in experienced hands this procedure may be a valuable surgical tool for the treatment of large ovarian endometriomas. However, great care must be taken to avoid ovarian damage.