Weigh the pros and cons to ovarian reserve before stripping ovarian endometriomas prior to IVF/ICSI: A meta-analysis.

Xin Tao,Xin Tao,Lisi Cai,Shuqi Ge,Shuqi Ge,Lei Chen,Lei Chen,Wan-Xi Yang

doi:10.1371/journal.pone.0177426

Xin Tao, Xin Tao + Show 6 more

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https://doi.org/10.1371/journal.pone.0177426

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Abstract

PurposeTo explore the effects of conservative surgery for endometriomas on ovarian responsiveness during assisted reproductive technology (ART) and provide reproductive and gynecological doctors with a more reliable reference program for the treatment of endometriomas.MethodsA literature search was performed by searching the PubMed, Embase, Cochrane Library, Web of Science and Science Direct databases. Studies with inter- and intra-patient comparisons of ovarian responses and oocyte quality between operated and unoperated ovaries and that met the inclusion criteria were retrieved, and the data from the outcome measures were extracted and pooled for this meta-analysis.ResultsTwenty-one published studies (2649 ART cycles) were included. The total amount of gonadotropin (Gn) used (inverse variance (IV):0.48; 95% confidence interval (CI): [0.13, 1.82], P = 0.0007) was significantly increased in the women with endometriomas who had a history of cystectomy. The estrogen (E) level on the day of hCG administration (IV: -0.29; 95% CI: [-0.41, -0.17], P<0.00001), the number of mature or dominant follicles (IV: -1.17; 95% CI: [-1.51, -0.82], P<0.00001) and the total number of oocytes retrieved (IV: -1.78; 95% CI: [-2.38, -1.17], P<0.00001) were significantly decreased in the women with endometriomas who had a history of cystectomy. The duration of stimulation (IV: 0.02; 95% CI: [-0.09, 0.13], P = 0.77), the total number of formed embryos (IV: -0.06; 95% CI: [-0.17, 0.04], P = 0.25), the pregnancy rate(IV:0.98;95%CI[0.82,1.18], P = 0.83) and the live birth rate(IV:0.93;95%CI[0.70,1.23], P = 0.61)were not statistically different between the two groups. Similar intra-patient results were found in the number of mature or dominant follicles (IV: -0.88; 95% CI: [-1.25, -0.52], P<0.00001) and the total number of oocytes retrieved (IV: -3.48; 95% CI: [-4.77, -2.19], P<0.00001).ConclusionART might be a better therapeutic method for ovarian endometrioma-related infertility than cystectomy.

Highlights

Ovarian endometriomas are one of the most common benign lesions in gynecology and mainly occur in reproductive-aged women
The total amount of gonadotropin (Gn) used (inverse variance (IV):0.48; 95% confidence interval (CI): [0.13, 1.82], P = 0.0007) was significantly increased in the women with endometriomas who had a history of cystectomy
The estrogen (E) level on the day of hCG administration (IV: -0.29; 95% CI: [-0.41, -0.17], P

Summary

Introduction

Ovarian endometriomas are one of the most common benign lesions in gynecology and mainly occur in reproductive-aged women. Endometriomas in infertile patients have been a clinical challenge for infertility specialists. These patients often present with infertility and are eager to achieve their reproductive needs through assisted reproductive technology (ART). Some studies have shown that endometriomas will not damage ovarian reserves[1] and rarely damages oocyte quality[2]. Other studies have supported the opposite view and found that endometrioma cystectomies may damage the ovarian response to controlled ovarian hyperstimulation (COH) and weaken the ovarian reserves[4,5,6,7]. Another study showed that the existence of an endometrioma affects iron metabolism in follicular fluid, increases the amount of oxygen free radicals and results in egg quality injury[8]

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