Abstract
Abstract Study question Is oocyte competence affected in patients with ovarian endometriosis in IVF/ICSI cycles? Summary answer In IVF cycles ovarian endometrioma negatively impacts oocyte quality in terms of oocytes and mature (MII) oocytes retrieved but not the fertilization and blastulation rates. What is known already Is still controversial whether the presence of a non-surgically treated ovarian endometrioma alone may adversely affect the oocyte quality in IVF/ICSI treatments. As oocyte quality is well reflected by the ability to complete maturation and undergo successful fertilization, the best clinical markers of oocyte competence are represented by number of MII oocytes retrieved and fertilization rates. Even though women with endometriomas had fewer oocytes and MII oocytes retrieved than women without, no further differences in reproductive outcomes have been found. The most recent meta-analysis, however, has serious limitations, such as clinical heterogeneity of the studies and a small sample size. Study design, size, duration A systematic review and meta-analysis of studies evaluating clinical markers of oocyte competence in women with ovarian endometriosis were conducted. Electronic searches were performed in PubMed, Cochrane database, and ClinicalTrials.gov up to December 2022. Randomized controlled trials and observational studies were eligible for inclusion. The risk of bias was assessed using the Newcastle–Ottawa Quality Assessment Scale. The quality of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Participants/materials, setting, methods Studies reporting ART outcomes among women with endometrioma were included. The main outcomes were clinical markers of oocyte competence including the number of oocytes retrieved, MII oocytes retrieved, ovarian sensitivity index (OSI), fertilization and blastulation rates. Mean differences (MD) and odds ratios (ORs) with 95% confidence intervals (CI) were calculated using the random and fixed effects model. Main results and the role of chance Of 876 unique records identified, 30 studies met inclusion criteria, and 21 studies, totaling 5962 participants, were included in the meta-analysis. The results showed that significantly fewer oocytes retrieved (mean difference (MD) = -1.67; 95% confidence interval (CI), -2.46, -0.88; p = <0.0001; I2=92%; low quality) and MII oocytes (MD = -2.45; 95% CI, -3.23, -1.67; p = <0.0001; I2=86%; moderate quality) were observed in women with endometriomas compared with the control. However, the OSI (MD = -1.47; 95% CI, -3.74, 0.81; p = 0.21; I2=97%; very low quality), fertilization rate (Odds ratio (OR) = 1.04; 95% CI, 0.78, 1.39; p = 0.79; I2=93%; low quality) and blastulation rate (OR = 0.90; 95% CI, 0.66, 1.22; p = 0.51; I2=95%; low quality) were not significantly different between the groups. Limitations, reasons for caution Despite removing patients with previous surgeries and diverse stages of endometriosis, main outcomes showed significant heterogeneity. The unilaterality/bilaterality, size, and the general extent of endometriomas could cause this heterogeneity. The quality of evidence generated from our findings is low, mainly due to the factors mentioned above. Wider implications of the findings Our findings suggest that endometriomas do not hinder fertility chances, as fertilization and blastulation rates were not compromised. Due to the risk of ovarian damage, these results argue against endometrioma excision. Further clinical trials with adequately-powered sample sizes should focus on blastulation and euploidy rates to validate our findings. Trial registration number Not applicable
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