Should we operate ovarian endometriomas prior to IVF?

Abstract

Objective: The effect of ovarian endometriomas on the response to controlled ovarian hyperstimulation is still controversial. Several authors have proposed laparoscopic ovarian cystectomy prior to IVF, but the effect of this surgery on ovarian function remains unknown. Several reports have appeared in the recent literature comparing IVF outcome in women with previous endometriomas that have undergone surgery versus tubal disease. However, in order to validate if surgery is useful in these patients, we should compare women with endometriomas undergoing IVF versus women with previous surgery due to endometrioma undergoing IVF.Design: Retrospective chart review.Materials/Methods: We have reviewed 127 patients that underwent IVF at our center from 1999 to 2001, 50 of which had at least one endometrioma >3cm (mean age 34.1 years) and compared their IVF outcome with those patients who had an ovarian endometrioma removed prior to the IVF procedure, maximum 3 months after the surgery (n=87, mean age 34.4 years). Laparoscopic surgery included cystectomy and bipolar coagulation of the remaining lesions.Results: Similar cycle outcome in terms of length of stimulation, total FSH required, peak estradiol levels, number of oocytes retrieved and embryos obtained, fertilization and pregnancy rates were obtained in both groups, regardless ovarian endometrioma was previously removed by laparoscopy or present at the time of IVF procedure. Table TableCycle outcomeStimu- lation daysTotal FSHE2 (pg/mL)OocytesEmbryosEmbr. trans- ferredFertili -zation rate (%)Preg- nancy rate (%)endometrioma8.61825214011.56.12.35041previous surgery9.31923188210.45.6248.443 Open table in a new tab Conclusions: Patients with a present ovarian endometrioma >3cm show a similar IVF outcome than those patients with previous removal of the endometriotic cyst. Although laparoscopic cystectomy does not compromise the ovarian response to IVF, it does not offer any additional benefit. Proceeding directly to IVF in patients with ovarian endometriomas may reduce time to achieve a pregnancy and the hypothetical complications of laparoscopic surgery while diminishing the costs for the patient. Objective: The effect of ovarian endometriomas on the response to controlled ovarian hyperstimulation is still controversial. Several authors have proposed laparoscopic ovarian cystectomy prior to IVF, but the effect of this surgery on ovarian function remains unknown. Several reports have appeared in the recent literature comparing IVF outcome in women with previous endometriomas that have undergone surgery versus tubal disease. However, in order to validate if surgery is useful in these patients, we should compare women with endometriomas undergoing IVF versus women with previous surgery due to endometrioma undergoing IVF. Design: Retrospective chart review. Materials/Methods: We have reviewed 127 patients that underwent IVF at our center from 1999 to 2001, 50 of which had at least one endometrioma >3cm (mean age 34.1 years) and compared their IVF outcome with those patients who had an ovarian endometrioma removed prior to the IVF procedure, maximum 3 months after the surgery (n=87, mean age 34.4 years). Laparoscopic surgery included cystectomy and bipolar coagulation of the remaining lesions. Results: Similar cycle outcome in terms of length of stimulation, total FSH required, peak estradiol levels, number of oocytes retrieved and embryos obtained, fertilization and pregnancy rates were obtained in both groups, regardless ovarian endometrioma was previously removed by laparoscopy or present at the time of IVF procedure. Table Conclusions: Patients with a present ovarian endometrioma >3cm show a similar IVF outcome than those patients with previous removal of the endometriotic cyst. Although laparoscopic cystectomy does not compromise the ovarian response to IVF, it does not offer any additional benefit. Proceeding directly to IVF in patients with ovarian endometriomas may reduce time to achieve a pregnancy and the hypothetical complications of laparoscopic surgery while diminishing the costs for the patient.