Removal of Endometriomas Before in vitro Fertilization Does Not Improve Fertility Outcomes: A Matched, Case-Control Study

Abstract

Debate continues about the effect of ovarian endometriomas on techniques of assisted reproduction. Possibly, an ovarian endometriotic cyst could impair oocyte quality and limit the response to ovarian hyperstimulation. Alternately, previous surgery may be the problem, not the endometriosis itself. This retrospective case-control study, conducted in connection with 2 academic in vitro fertilization (IVF) programs, examined outcomes in 189 women with endometriosis who underwent IVF with embryo transfer. Of these patients, 133 had previously undergone laparoscopic cystectomy for an ovarian endometrioma. The remaining 56 women proceeded directly to IVF. The diagnosis of endometrioma was confirmed histologically in all surgical cases. None of the participants had a known infertility factor other than endometriosis. The case and control women were similar with respect to age and ovarian reserve, and there were no significant differences in the duration of stimulation. There were, however, significant differences in the total dose of gonadotropins administered and peak estradiol levels on the day of giving human chorionic gonadotropin. These differences favored the women who went directly to controlled ovarian hyperstimulation. Comparable numbers of mature oocytes were obtained from women in the 2 groups. No significant group differences were found in fertilization rate, the number of embryos obtained per cycle, or the number of embryos transferred. Finally, rates of implantation, pregnancy, and miscarriage were similar in the 2 groups. Although laparoscopic cystectomy for ovarian endometriosis does not impair oocyte quality, it also does not offer superior fertility outcomes to asymptomatic women. Proceeding directly to controlled ovarian hyperstimulation in women who lack symptoms might reduce the time to pregnancy and lower patient costs as well as avoiding possible surgical complications. Symptomatic women may be told that conservative ovarian surgery does not lessen the chance of successful IVF.