Endometrioma Recurrence Research Articles

Ovarian endometrioma recurrence after laparoscopic surgery: First assessment of ACSAP predicting score.

We aimed to develop and validate a predictive score to estimate the post-operative recurrence risk after laparoscopic excision of ovarian endometrioma (OMA). The prediction score was developed using a training set comprising 431 patients with OMA who underwent laparoscopic surgery at our institution between January 2015 and September 2017. A follow-up period of at least 5 years was required. Clinical data were entered into least absolute shrinkage and selection operator (LASSO) regression to build a scoring system that predicted OMA recurrence. A testing set containing 185 patients from October 2017 to October 2018 was used to assess its performance. Based on LASSO regression, the final score (ACSAP score) included five clinical predictors (0-15 points): Age, cyst size, previous surgery for OMA, revised American Society for Reproductive Medicine stage and post-operative pregnancy. The area under the curve values of the score were 0.741 (0.765) and 0.727 (0.795) for predicting 3-year and 5-year OMA recurrence, respectively, in the training (testing) set. The score stratified patients into three risk groups in both sets, with significant differences in the 5-year recurrence rates (low-risk, 5.3% [0%]; intermediate-risk, 20.2% [16.5%] and high-risk, 48.0% [36.5%]; P < 0.001). Moreover, patients in the intermediate- and high-risk groups exhibited a significant reduction in the 5-year cumulative recurrence following a minimum of 15-month post-operative medical treatment (both P < 0.05). The ACSAP score may be a concise and useful tool for identifying patients with a higher risk of OMA recurrence after surgery who might receive long-term post-operative medical treatment.

Pathophysiology and Clinical Implications of Ovarian Endometriomas.

Ovarian endometriomas affect many patients with endometriosis and have significant effects on quality of life, fertility, and risk of malignancy. Endometriomas range from small (1-3 cm), densely fibrotic cysts to large (20 cm or greater) cysts with varying degrees of fibrosis. Endometriomas are hypothesized to form from endometriotic invasion or metaplasia of functional cysts or alternatively from ovarian surface endometriosis that bleeds into the ovarian cortex. Different mechanisms of endometrioma formation may help explain the phenotypic variability observed among endometriomas. Laparoscopic surgery is the preferred first-line modality of diagnosis and treatment of endometriomas. Ovarian cystectomy is preferred over cyst ablation or sclerotherapy for enabling pathologic diagnosis, improving symptoms, preventing recurrence, and optimizing fertility outcomes. Cystectomy for small, densely adherent endometriomas is made challenging by dense fibrosis of the cyst capsule obliterating the plane with normal ovarian cortex, whereas cystectomy for large endometriomas can carry unique challenges as a result of adhesions between the cyst and pelvic structures. Preoperative and postoperative hormonal suppression can improve operative outcomes and decrease the risk of endometrioma recurrence. Whether the optimal management, fertility consequences, and malignant potential of endometriomas vary on the basis of size and phenotype remains to be fully explored.

Analysis of Risk Factors for Bleeding and Recurrence of Ovarian Endometriomas after Laparoscopic Surgery and Its Impact on Pregnancy Outcomes

Analysis of Risk Factors for Bleeding and Recurrence of Ovarian Endometriomas after Laparoscopic Surgery and Its Impact on Pregnancy Outcomes

Characteristics of Endometrioma Recurrence Patients

Objective: To identify the characteristics of endometrioma recurrence cases. Method: This study was a descriptive retrospective, using secondary data taken from all medical records of Clinic Aster and Medical Records Installation in Dr. Hasan Sadikin General Hospital, Bandung, from 1st January 2018 – 31st December 2022. Data were presented in tables. Results: Of the 37 endometrioma recurrences, most of the patients are 20 to 35 in age. None of them has a parity history after the first surgical procedure. Both previous and recent cases are dominantly unilateral endometriomas. The history of postoperative medication is higher (54,1%). Obstetricians/Gynecologists appear to perform the most surgical procedure (67,6%). Mass is the main clinical manifestation of the recurrence. While menstrual and BMI profiles appear to be normal. Conclusions: The characteristic of the recurrence of endometrioma is related parity status after the first surgery, history of the previous medical treatment, and previous form of endometrioma are related to the current characteristic of endometrioma (age, lesion form, clinical manifestation, and recurrence interval).

Characteristics of Endometrioma Recurrence Patients

Objective: To identify the characteristics of endometrioma recurrence cases. Method: This study was a descriptive retrospective, using secondary data taken from all medical records of Clinic Aster and Medical Records Installation in Dr. Hasan Sadikin General Hospital, Bandung, from 1st January 2018 – 31st December 2022. Data were presented in tables.Results: Of the 37 endometrioma recurrences, most of the patients are 20 to 35 in age. None of them has a parity history after the first surgical procedure. Both previous and recent cases are dominantly unilateral endometriomas. The history of postoperative medication is higher (54,1%). Obstetricians/Gynecologists appear to perform the most surgical procedure (67,6%). Mass is the main clinical manifestation of the recurrence. While menstrual and BMI profiles appear to be normal.Conclusions: The characteristic of the recurrence of endometrioma is related parity status after the first surgery, history of the previous medical treatment, and previous form of endometrioma are related to the current characteristic of endometrioma (age, lesion form, clinical manifestation, and recurrence interval).Karakteristik Pasien Endometrioma RekurenAbstrakTujuan: Mengetahui karakteristik dari pasien endometrioma rekuren.Metode: Penelitian ini merupakan penelitian deskripsi retrospektif dengan menggunakan data sekunder yang diambil dari seluruh rekam medis pasien kista endometriosis rekuren di Klinik Aster dan Instalasi Rekam Medis di Rumah Sakit Umum Pusat Dr. Hasan Sadikin Bandung dengan periode 1 Januari 2018 – 31 Desember 2022. Kemudian, data-data disajikan dalam bentuk tabel. . Hasil: Dari 37 kasus e ndometrioma rekuren, sebagian besar pasien berusia 20 hingga 35 tahun. Seluruh pasien tidak mempunyai riwayat paritas setelah prosedur pembedahan sebelumnya. Baik kasus-kasus kista endometriosis sebelumnya maupun yang kambuh, keduanya dominan dalam bentuk unilateral. Riwayat pengobatan pasca operasi lebih tinggi (54,1%). Dokter Spesialis Obstetri/Ginekologi tampak melakukan tindakan pembedahan terbanyak (67,6%). Massa adalah manifestasi klinis utama dari kekambuhan. Selain itu, profil menstruasi dan BMI tampak normal.Kesimpulan: Karakteristik pada endometrioma rekuren berkaitan dengan status paritas setelah operasi pertama, riwayat pengobatan medis sebelumnya, dan bentuk endometrioma sebelumnya berhubungan dengan karakteristik endometrioma saat ini (usia, bentuk lesi, manifestasi klinis, dan rentang rekurensi)Kata kunci: karakteristik, rekuren, endometrioma

Women operated for recurrent endometrioma exhibit more multiple deep infiltrating endometriosis lesions

ObjectiveTo determine whether recurrent endometriomas are associated with multiple deep infiltrating endometriosis (DIE) lesions. Study DesignThis was an observational, cross-sectional, cohort study of 611 consecutive symptomatic women with endometrioma who underwent surgical treatment. We compared 124 patients with previous surgery for endometrioma (study group, PSO(+)) versus 487 patients without previous surgery for endometrioma (control group, PSO(−)). The primary outcome was the presence of multiple (≥2) DIE lesions. The secondary outcomes included painful associated symptoms, the presence of intestinal lesions, and the mean total revised American Society for Reproductive Medicine (rASMR) scores. ResultsThe occurrence of DIE lesions was higher in the PSO(+) group than in the PSO(−) group (67.7% vs. 37.3%, respectively; p < 0.01). Among the patients with DIE, more patients had multiple (≥ 2) lesions in the PSO(+) group than in the PSO(−) group: 91.7% vs. 77.8%, respectively; p < 0.01. The patients in the PSO(+) group had more painful symptoms than did the patients in the PSO(−) group (90.9% vs. 74.5%, respectively; p < 0.01). Intestinal lesions were more frequently observed in the PSO(+) group than in the PSO(−) group: 55.6% vs. 19.1%, respectively; p < 0.01. The patients in the PSO(+) group had a higher rASRM mean score than the patients in the PSO(−) group (65.0 vs. 46.1, respectively; p < 0.01). After adjusting for confounding factors, PSO was significantly associated with the presence of multiple DIE lesions (OR 4.1). ConclusionsRecurrence of endometrioma is a marker of DIE severity with more multiple lesions.

The Role of Reproductive Surgeons/Surgery has Got Rekindled with Plateauing of IVF Results and Advances in Technology: A Comprehensive Narrative Review

Earlier we have reviewed the role of surgery in need for fibroids removal prior to IVF in improving success rates, management of inoperable recurrent endometrioma presenting as severe incapacitating pain following leuprolide acetate depot by aspiration, recurring again at 2 years subsequently for sclerosing therapy presented as a case report updated advances in classification along with re¬productive surgeries in mullerian anomalies. Updated management of oncofertility-does the use of vsels appear practical in the near future in human malignancies replacing cortical tissue and testicular tissue, autologous Platelet Rich Plasma (PRP) probability of it becoming a revolutionary therapy in the field of gynaecology and reproductive endocrinology and infertility, role of surgery in endometriomas and endometriosis, adenomyomas, tubal surgery. Here we have tried to outline how prior to the invention of In Vitro Fertilization (IVF), reproductive surgeries which were believed to be fertility sparing were properly acknowledged, role of reproductive surgeons became obsolete. With the plateauing of IVF result interest has got rekindled with considerable advantages of reproductive surgeries is this field. Additionally, newer instrumentation as well as along with surgical procedure has evoked and made it attractivefor reproductive surgeons for improvementof their expertise with regards to conservation of future fertility as well as train future Reproductive Endocrinology and Infertility specialist (REI) in view of solidifying this field of yielding pregnancies to maximum of infertile cases even in patients having cancer surgeries or earlier cryopreservation of oocytes in say patients with turners syndrome etc.

Effect of catheter-directed ethanol sclerotherapy on ovarian reserve in patients with recurrent endometrioma: comparative analysis with primary endometriosis.

Catheter-directed ethanol sclerotherapy (CDS) is known to less affect the ovarian function, with comparable efficacy. This study aims to investigate the change in ovarian reserve after catheter-directed ethanol sclerotherapy in patients with recurrent endometrioma, as compared to primary endometrioma. Retrospective, observational study. Electronic medical records and images of patients with endometrioma who underwent CDS from August 2014 to April 2022 at a single institution were obtained. Patients aged > 18years old and with anti-Müllerian hormone (AMH) level between 0.8 and 10.0 with regular menstruation were enrolled. Cyst diameter, laterality, AMH level, and CA-125 level before and after 1month, 6months, 1year, 2years, and 3years of sclerotherapy were obtained. A total of 180 patients were fit for analysis. There was no statistical difference in age and cyst size between the two groups. Mean values of AMH in each group were 3.35 in the primary group and 3.00 in the recurrent group prior to the procedure (p = 0.347). There was no significant difference in delta value of AMH after sclerotherapy in both groups at each follow-up period. Also, this result was consistent when stratified by laterality, preprocedural AMH level, and initial size of endometrioma. No case of recurrence was reported in both groups. The effect of CDS on ovarian reserve is not inferior in recurrent endometrioma compared to primary endometrioma. Since sclerotherapy is known to less deteriorate the ovarian function than surgical removal of endometrioma, clinician could consider this as the first-line therapy in patients with recurrent endometrioma. Catheter-directed ethanol sclerotherapy for patients with recurrent endometrioma has similar effect on ovarian reserve compared to patients with primary endometrioma. • Secondary surgery for endometrioma has significant deleterious effect on ovarian function. • Catheter-directed sclerotherapy (CDS) for endometrioma had equally minimal adverse effect on ovarian reserve, represented as anti-Müllerian hormone (AMH), in both primary and recurrent groups. • Physicians should consider CDS for patients with recurrent endometrioma who desire to preserve ovarian function.

Cumulative pregnancy rate via multiple fresh or frozen embryo transfers in women with current, resected, or recurred endometrioma.

This study aimed to retrospectively analyze the cumulative pregnancy rate (PR) via multiple fresh or frozen embryo transfers (ET) in women with current, resected, or recurred endometrioma. The IVF data including oocyte pick-up (OPU) and fresh or frozen ET in women with current (37 women; 56 OPU, 18 fresh and 14 frozen ET), resected (24 women; 50 OPU, 17 fresh and 42 frozen ET), or recurred endometrioma (28 women; 49 OPU, 22 fresh and 24 frozen ET) were obtained. All cycles were performed from 2015 to 2022 in a single university hospital. The median serum AMH level (ng/mL) was 1.44, 1.47, and 0.98, respectively. The number of total or mature oocytes, fertilized oocytes, cleavage embryos at day-3, and top-quality embryos at day-3 were all similar in the three groups. Cycles with no oocyte occurred in 2 (3.6%), 1 (2%), and 3 cycles (6.1%), respectively. Freeze-all was performed in 46.3%, 59.2%, and 47.8% of the cycles, respectively (p>0.05). The cumulative clinical PR per total ET (43.8%, 25.4%, and 21.7%), per OPU (25%, 30%, and 20.4%), and per woman (37.8%, 62.5%, and 35.7%) were all similar in the three groups. The cumulative ongoing pregnancy and live birth rate per total ET, per OPU, and per woman were also similar in the three groups. Similarity in ovarian reserve, number of oocytes, number of embryos, cumulative clinical PR, and live birth in the three endometriosis groups indicates that the IVF outcomes in the 'recurrent endometrioma' group are not inferior to 'current' or 'resected' group.

Perioperative hormone treatment of endometriosis.

The use of hormonally suppressive medication to reduce levels of reproductive hormones around the time of surgery is widely used in the management of endometriosis. This review summarizes the current evidence concerning the perioperative use of hormonal treatment in the management of endometriosis. European Society of Human Reproduction and Embryology (ESHRE) guidanceSurgical Outcomes and Complications of Laparoscopic Hysterectomy for Endometriosis: A Multicentre Cohort StudyPre and postsurgical medical therapy for endometriosis surgery. Cochrane 2020Postoperative hormonal treatment for prevention of endometrioma recurrence after ovarian cystectomy: a systematic review and network meta-analysis. BJOG 2021. The literature highlights the importance of hormonal treatment for symptom relief, reduced surgical complications and postoperative benefits, including a reduction in pain, disease recurrence and improved pregnancy rates. The treatment of endometriosis can be broadly categorized into medical, commonly using hormonal suppression medications and surgical, in which endometriosis tissue is excised or ablated. This review aims to outline current management strategies and examines the relationship between the two treatment modalities.

Factors associated with recurrent endometriomas after surgical excision

BackgroundEndometriosis affects women in reproductive age and causes a great impact on their lives. When affecting the ovary, excision represents the main management option. However, recurrence represents a challenging situation for patients and physicians. This study aimed to determine factors contributing to endometriomas recurrence after surgical excision.ResultsThis was a quasi-experimental study recruiting 60 patients with ovarian endometrioma. The mean age was 30.33 ± 7.95 years. The mean parity was 1.27 ± 0.69. The recurrence rate after excision was 11/60 (18.3%) after a mean follow-up period of 22.62 ± 4.96 months. None of the patients’ characteristics or endometriosis-related characteristics were significant factors contributing to cyst recurrence (age, parity, history of infertility, preoperative endometrioma diameter, preoperative AFC, preoperative AMH, degree of pelvic pain, degree of dysmenorrhea, degree of dyspareunia, pelvic tenderness, and induration) (p value > 0.05).ConclusionThe patient’s related factors and endometrioma characteristics did not predict its recurrence.

The role of levonorgestrel-releasing intrauterine system for recurrence prevention after conservative surgery among patients with coexistent ovarian endometrioma and diffuse adenomyosis: A retrospective case control study with long-term follow up.

When ovarian endometrioma coexist with adenomyosis, the risk of postoperative recurrence increased. How is the effect of levonorgestrel-releasing intrauterine system (LNG-IUS) on symptomatic recurrence for those patients was unknown. This study retrospectively analyzed 119 women with coexistent endometrioma and diffuse adenomyosis who received laparoscopic excision of pelvic endometriosis from January 2009 to April 2013. Women were categorized into two groups: intervention group with LNG-IUS and control group with expectant observation after surgery. Data were compared in terms of preoperative history, laboratory and intraoperative findings, and clinical outcomes during follow-up, including pain regression, changes in uterine volume and recurrence. During a median 79 months (range, 6-107) of follow-up, patients with LNG-IUS experienced a significantly lower symptomatic recurrence of either ovarian endometrioma or dysmenorrhea (11.1% vs. 31.1%, p=0.013), compared with women under expectant observation by Kaplan-Meier survival analysis (χ2=5.448, p=0.020) and Cox univariate assessment (hazard ratio of 0.336, 95% confidence interval 0.128-0.885, p=0.027). Patients treated with LNG-IUS demonstrated a more prominent reduction in uterine volume (-14.1±20.9vs. 8.7±48.8, p=0.003) and higher percentage of complete pain remission (95.6% vs. 86.5%). For multivariate analysis, use of LNG-IUS (aHR 0.159, 95%CI 0.033-0.760, p=0.021) and severity of dysmenorrhea (aHR 4.238, 95%CI 1.191-15.082, p=0.026) were two independent factors associated with overall recurrence. Postoperative insertion of LNG-IUS may prevent recurrence in symptomatic women with comorbidity of ovarian endometrioma and diffuse adenomyosis.

Presence of endometrioma decreased blastocyst formation rate but not impair Assisted Reproductive Technology (ART) outcome.

This study aims to assess the impact of endometrioma on patients who undergo ART treatment due to endometriosis. A retrospective study was conducted on women ≤ 40years of age who underwent ART treatment at an academic medical center between January 2014 and December 2020. Two-hundred-and-eight women had received IVF/ICSI treatment due to endometriosis and there were 89 patients presence of endometrioma. Patients were further divided into primary endometrioma, recurrent endometrioma and those having received cystectomy for endometrioma prior to IVF/ICSI. The control group included 624 infertile women without endometriosis. In the endometrioma subgroup (B) the blastocyst formation rate was significantly lower when compared with the endometriosis (A) and control groups (C). The cumulative live birth rates (CLBRs) (60.5% versus 49.4% versus 56.9%, p = 0.194 in A versus B, p = 0.406 in A versus C, p = 0.878 in B versus C) were comparable. Multiple logistic regression analysis revealed that female age, total FSH dose and blastocyst formation rate were the significant variables in predicting CLBR (OR 0.89, CI 0.80-0.99, p < 0.025, OR 0.68 CI 0.53-0.88, p = 0.003 and OR 30.04, CI 9.93-90.9, p < 0.001, respectively). The CLBRs were comparable at 47.1%, 60% and 57.9% in the primary endometrioma, s/p cystectomy and recurrent endometrioma group. Although the blastocyst formation rate was lower in the endometrioma group, CLBR was not worse than those who were in the endometriosis or control group. Cystectomy for endometrioma did not alter IVF/ICSI outcomes if the ovarian reserve was comparable. Recurrent endometrioma did not worsen IVF/ICSI outcomes than primary endometrioma.

Репродуктологические аспекты проблемы консервативного хирургического лечения эндометриоидных кист яичников

The aim is to clarify the timing of recurrence of endometriomas removed and the dependence of the ovarian reserve status on the number of ovarian resections performed, as well as to assess the awareness of patients about the impact of surgical treatment of endometrioid ovarian cysts (EOC) on reproductive function and therapeutic effectiveness of in vitro fertilization (IVF) technology. Material and methods. In 93 infertile patients with EOC and values of anti-muller hormone (AMH) &lt; 1.2 ng/ml, the dependence of the degree of reduction of this hormone on the number of operations performed with relapses of endometrioma was analyzed. Using standard research methods in the same patients, the prevalence of infertility factors identified in the International Classification of Diseases of the 10th revision was studied in parallel, and women's awareness of the impact of surgical treatment of EOC on reproductive potential was clarified. Results. Other forms of endometriosis were found in 71% of women with EOC, and the observed infertility, which necessitated the appointment of IVF, was mainly associated with confirmed male and tubal factors. Among the patients operated on for EOC with a reduced level of AMH, the majority underwent repeated ovarian resections due to relapses of endometriomas that occurred within two and a half years after their removal. The degree of decrease in the level of AMH was directly dependent on the number of operations performed. During surgical treatment of EOC, only 7.5% of patients received relevant information about their frequent recurrence and possible consequences for the reproductive function of ovarian resection performed (especially multiple). Conclusions. Frequent recurrence of EOC, which forces repeated resections of the ovaries, is an obvious factor that, due to the reduction of the ovarian reserve, prevents the successful use of IVF technology with its own oocytes in situations where this method of infertility treatment is in demand. When planning the removal of EOC in women of reproductive age, surgeons should necessarily refer patients to reproductologists for advice on issues related to the implementation of reproductive plans both in the near and long term

Treatment after endometrioma recurrence: a narrative review.

Ovarian endometrioma is a common subtype of endometriosis with a prevalence between 17 and 44%. The reported average recurrence of endometrioma after surgical management is 21.5% after 2 years and 40-50% after 5 years. The aim of this narrative review was to summarize the existing literature focusing on treatment options after endometrioma recurrence in order to provide an evidence-based approach for the clinical practice. Three electronic databases (MEDLINE, EMBASE and Cochrane) were searched until September 2022 for eligible studies. The available studies showed that repeated surgery has a negative impact on ovarian function, without improving the fertility outcomes. Transvaginal aspiration as an alternative option for surgery has a high rate of recurrence, which varies from 8.20 to 43.5% depending on the technique used and on the study population. Pregnancy related outcomes were similar between transvaginal aspiration groups and no intervention groups in patients with endometrioma recurrence. Regarding medical treatments, only four studies were found, showing that progestins reduce the pain and the diameter of the ovarian cyst. Recurrent endometrioma is a challenging condition which could be encountered during the care of women with endometriosis. The decision about the treatment-strategy has to be individualized considering family planning status, age, ovarian reserve and transvaginal ultrasound findings. Well-designed randomized clinical trials are needed to export safer conclusions about the most appropriate treatment in each specific condition after endometrioma recurrence.

Use of Oxidized Regenerated Cellulose (ORC) in treatment of ovarian endometriomas to prevent recurrence and preserve ovarian reserve

Background: Oxidized Regenerated Cellulose (ORC) is used in the treatment of Endometriosis to eliminate or postpone endometriomas’ recurrence and to preserve ovarian reserve subsequently increasing pregnancy rate. The aim of this research was to evaluate the benefit of ORC in surgical management of ovarian endometriomas to reduce the rate of recurrence while preserving ovarian reserve. Methods: This prospective randomized controlled research was carried out on 60 cases, divided into two groups: Group A (drainage and ablation): 30 cases had laparoscopic drainage of ovarian endometrioma with electrocautery of the endometriomal cyst wall. Group B (drainage and ORC): 30 cases had laparoscopic drainage of ovarian endometrioma with insertion of ORC inside the cyst cavity. Results: There was a statistically significant difference according to 3 and 6 months in anti-mullerian hormone (AMH) (ng/ml) and Antral Follicular Count (AFC) being higher in ORC group compared to ablation group while the reduction in AMH (change) was significantly lower in ORC group (P values< 0.001). The recurrence rate of ovarian endometrioma was comparable between both groups. AMH and AFC was significantly associated with the recurrence of ovarian endometrioma 3 and 6 months. Conclusions: ORC reduces effectively the recurrence risk of endometriomas following laparoscopic drainage.

The Clinical Picture and Fecundity of Primary and Recurrent Ovarian Endometriosis with Family History: A Retrospective Analysis

This study aims to evaluate the role of endometriosis family history on the clinical manifestation and fertility performance of primary and recurrent endometriosis. In total, 312 primary and 323 recurrent endometrioma patients with a histological diagnosis were included in this study. Family history was significantly correlated with recurrent endometriosis (adjusted OR: 3.52, 95% CI: 1.09-9.46, p = 0.008). Patients with a family history showed a significantly higher proportion of recurrent endometriosis (75.76% vs. 49.50%), higher rASRM scores, higher incidence of severe dysmenorrhea, and severe pelvic pain than the sporadic cases. Recurrent endometrioma showed statistical increase in rASRM scores, percentage of rASRM Stage IV, dysmenorrhea, dyschezia, those undergoing semi-radical surgery or unilateral oophorosalpingectomy, postoperative medical treatment, e with a positive family history, while a decrease in the incidence of asymptomatic phenomena and those undergoing ovarian cystectomy compared to those with primary endometriosis. The naturally conceived pregnancy rate was higher in primary endometriosis compared to recurrent endometriosis. Compared to recurrent endometriosis with a negative family history, recurrent endometriosis with a positive family history had a higher incidence of severe dysmenorrhea, chronic pelvic pain, a higher spontaneous abortion rate, and a lower natural pregnancy rate. Primary endometriosis with a family history presented a higher incidence of severe dysmenorrhea than those without a family history. In conclusion, endometriosis patients with a positive family history presented a higher pain severity and lower conception probability compared to the sporadic cases. Recurrent endometriosis showed further-exacerbated clinical manifestations, more pronounced familial tendency, and lower pregnancy rates than primary endometriosis.

Status and related factors of postoperative recurrence of ovarian endometriosis: a cross-sectional study of 874 cases

PurposeExploring the status and related factors of postoperative recurrence of ovarian endometriosis.MethodsThis study analyzed the results of questionnaires conducted in 27 hospitals across the country from January 2019 to November 2021. All women were divided into recurrence group and non-recurrence group to analyze the recurrence rate and related factors after ovarian endometriosis surgery.ResultsThe recurrence rates of ovarian endometriosis within 1 year, 1–2 years, 2–3 years, 3–4 years, 4–5 years and more than 5 years were 6.27%, 35.85%, 55.38%, 65.00% and 56.82%, respectively. Significant differences were found between two groups in terms of age at surgery (OR: 0.342, 95%CI: 0.244–0.481, P < 0.001), presence of dysmenorrhea (OR: 1.758, 95%CI: 1.337–2.312, P < 0.001), presence of adenomyosis (OR: 1.948, 95%CI: 1.417–2.678, P < 0.001) and family history of endometriosis or adenomyosis (OR: 1.678, 95%CI: 1.035–2.721, P = 0.021). The age at surgery (OR: 0.358, 95%CI: 0.253–0.506, P < 0.001), presence of dysmenorrhea (OR: 1.379, 95%CI: 1.026–1.853, P = 0.033) and presence of adenomyosis (OR: 1.799, 95%CI: 1.275–2.537, P = 0.001) were significantly associated with endometrioma recurrence in multivariate analysis. No significant associations were found between the recurrence rate and body mass index (BMI), educational background, age of menarche, gravida, parity, uterine leiomyoma, endometrial polyps or postoperative use of gonadotropin-releasing hormone agonist (GnRH-a).ConclusionsDysmenorrhea and presence of adenomyosis are independent risk factors for postoperative recurrence of ovarian endometriosis, and older age is an independent protective factor for postoperative recurrence.

Outcomes of ovarian endometrioma aspiration before ultra-long agonist protocol during ICSI cycles: a multicenter randomized clinical trial

Ovarian endometriomas negatively affect the outcomes of intracytoplasmic sperm injection (ICSI). Numerous procedures and medications have been used to reduce the negative impact of endometriomas on ICSI outcomes. Endometrioma aspiration is one such procedure with controversial results. Objective. To evaluate the therapeutic efficacy and reproductive outcomes of endometrioma aspiration before starting a long ICSI protocol with agonists. Patients and methods. This multicenter randomized clinical trial enrolled 84 women with small ovarian endometrioma (3–5 cm) previously diagnosed by ultrasound in five fertility centers in Egypt from July 2017 to June 2022. Participants were randomly allocated into two groups (n = 42/each). Group I underwent endometrioma aspiration prior to the ultra-long agonist protocol, and group II had only the ultra-long agonist protocol. The rate of clinical pregnancy, cycle cancellation, ovarian hyperstimulation syndrome, endometrioma recurrence, and pelvic infections were measured. Results. Endometrioma size decreased significantly after aspiration. The total dose of gonadotropins and the duration of stimulation were statistically significantly lower in group I compared to the control group (p &lt; 0.001 for both groups). The total number of retrieved and mature oocytes as well as the number of developed embryos were statistically significantly higher in group I than in the control group (p &lt; 0.001 for both groups). However, there were no statistically significant differences between the groups regarding embryo quality and the rates of pregnancy, miscarriage, and live births. Conclusion. Aspiration of small ovarian endometriomas before the ultra-long protocol in ICSI cycles reduced gonadotropin doses, shortened the stimulation period, and increased the number of retrieved oocytes. Nevertheless, there were no significant differences regarding embryo quality and pregnancy rates between the two groups. Key words: endometriosis, ICSI, ovulation, pregnancy

Recurrence, Reoperation, Pregnancy Rates, and Risk Factors for Recurrence after Ovarian Endometrioma Surgery: Long-Term Follow-Up of 756 Women.

The aims of this study were to evaluate the cumulative recurrence, reoperation, and pregnancy rates after ovarian endometrioma surgery at a single institution for more than a 5-year follow-up period. This study was conducted as a retrospective chart review of patients with ovarian endometrioma who underwent surgery between January 2008 and March 2016. Study subjects included premenopausal women with at least 5 years of follow-up. Exclusion criteria were patients with stage I or II ovarian endometrioma, those who underwent hysterectomy or bilateral oophorectomy, and presence of residual ovarian lesions on the first postoperative ultrasonography at 3-6 months. Recurrence was defined as a cystic mass by ultrasonography. A total of 756 patients were recruited. The median follow-up duration was 85.5 months (interquartile range, 71-107 months). Recurrent endometrioma was detected in 27.9% patients, and reoperation was performed in 8.3% patients. Cumulative rates at 24, 36, 60, and 120 months were 5.8%, 8.7%, 15.5% and 37.6%, respectively, for recurrence and 0.1%, 0.5%, 2.9%, and 15.1%, respectively, for reoperation. After multivariable analysis, age ≤31 years [hazard ratio (HR)=2.108; 95% confidence interval (CI)=1.522-2.921; p<0.001], no subsequent pregnancy (HR=1.851; 95% CI=1.309-2.617; p<0.001), and postoperative hormonal treatment ≤15 months (HR=2.869; 95% CI=2.088-3.941; p<0.001) were significant risk factors for recurrent endometrioma. Among 315 patients who desired pregnancy, 54.0% were able to have a successful pregnancy and delivery. Considering that longer postoperative hormonal treatment is the sole modifiable factor for recurrent endometrioma, we recommend long-term hormonal treatment until subsequent pregnancy, especially in younger women.