Could laparoscopic cystectomy improve intrauterine insemination with controlled ovarian hyperstimulation outcomes in women with endometrioma?

Abstract

Objectives: To clarify the effects of laparoscopic cystectomy of endometriomas on intrauterine insemination with controlled ovarian hyperstimulation (COH + IUI) success in women with the disease. Material and methods:We performed a retrospective study with endometrioma patients having at least one patent fallopian tube. The study group consisted of 57 infertile patients with a history of laparoscopic cystectomy who underwent 83 COH + IUI cycles. The control group consisted of 88 patients with endometrioma who underwent 161 COH + IUI cycles without surgery. Results:The total number of antral follicles was significantly lower in the study group than in the control group (10.1 ± 5.1 vs 11.9 ± 5.0; p = 0.008). No significant difference was observed in the clinical pregnancy and live birth rates per cycle [(9.6% vs 7.6%; p=0.7175 OR: 1.195% CI: 0.6-2.1) and (7.2% vs 6.2%; p = 0.9544 OR: 1.1 95% CI: 0.5-2.1], respectively) between the operated and non-operated groups. Conclusions:The results of the study show that the presence of an endometrioma with at least one patent fallopian tube does not require any cystectomy before COH+IUI treatment because no improvement was observed in the treatment outcomes of the patients who underwent preceding surgery. We conclude that an operation may be taken into consideration when malignancy cannot be ruled out or severe pelvic pain related to endometrioma cannot be relieved.

Surgical management of endometriosis to optimize fertility

“…not primarily for fertility). Although the total number of antral follicles in the surgery group was lower (likely of little clinical significance for patients undergoing IUI), there was no significant difference in clinical pregnancy rate or live birth rate per cycle [52 ▪▪ ].…”

“…To date, there is only one study comparing COS/IUI outcomes of surgical versus expectant management of endometriomas [52 ▪▪ ]. In this study, women were included if they had an endometrioma over 3 cm and at least one patent fallopian tube, and surgery was performed for pelvic pain unresponsive to medical management (i.e.…”