Effect of endometrioma cystectomy on IVF outcome: a prospective randomized study

Demi̇rol, Aygül; Güven, Süleyman; Baykal, Cem; Gürgan, Timur

doi:10.1016/s1472-6483(10)61192-3

Cited by 137 publications

(105 citation statements)

References 35 publications

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“…Evidence from a randomized controlled study of patients with endometrioma who either underwent intra-cytoplasmic sperm injection directly or after excision of the endometrioma showed a worse response to ovarian stimulation in the treated ovaries. However, no differences in pregnancy rates were detected (Demirol et al, 2006). Furthermore, there have been two systematic reviews and meta-analyses assessing the impact of surgery for endometriomas on ART outcomes.…”

Section: Results Analysis and Discussionmentioning

confidence: 99%

National survey of the current management of endometriomas in women undergoing assisted reproductive treatment

2012

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what is known already: The ideal management of endometriomas in women undergoing ART remains controversial and presents a dilemma to reproductive specialists. study design, size and duration: This was a national cross-sectional survey. A total of 388 gynaecologists completed the questionnaire.participants, settings and methods: All clinicians fully registered with the Royal College of Obstetricians and Gynaecologists were contacted. An 11-item survey was administered electronically using Survey Monkey software. Quantitative data were analysed using descriptive and comparative statistics.main results and the role of chance: The majority of responders were consultants (65%), 25% practiced ART and 65% performed laparoscopic surgery. Overall, 95% of responders would offer surgery for endometriomas in women undergoing ART, either on the basis of the size (.3-5 cm) of the endometrioma (52%), the presence of symptoms (16%), the presence of multiple/bilateral endometriomas (2%), regardless of the size and symptoms (19%) or only to women undergoing IVF (6%). The remaining 5% of responders would not offer surgery before ART. Excision was the most common surgical modality (68%), followed by ablation (25%). Laparoscopic surgeons were almost twice as likely to 'offer surgery to all patients with endometriomas prior to ART' compared with clinicians performing laparotomy (22 versus 12%, P , 0.001).limitations, reasons for caution: Our overall response rate, with answers to the questionnaire, was low (15%). However, the response rate amongst reproductive specialists was estimated at 60%. It is possible that there might have been an element of bias towards over-representation of responders who are more concerned about 'normalization' of the pelvic anatomy. Furthermore, our survey relied on self-reporting of practice and it is possible that being presented with a list of 'ideal' options may have resulted in respondent bias.wider implications of the findings: Despite the available evidence that surgery for endometriomas does not improve the outcome of ART and may damage ovarian reserve, it seems that the majority of gynaecologists in the UK offer ovarian cystectomy to their patients.

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Section: Results Analysis and Discussionmentioning

confidence: 99%

National survey of the current management of endometriomas in women undergoing assisted reproductive treatment

2012

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“…More recently, a study of 99 infertile couples randomized women to surgical excision of endometriomas prior to IVF-ICSI or immediate IVF-ICSI with the endometrioma aspirated at the time of oocyte collection. The study found that the pregnancy rate was similar between the groups [23].These results argue against excision of an endometrioma in women scheduled for IVF as surgery does not appear to improve the chance of pregnancy. Nevertheless, all endometriomas are not the same, and it appears that cysts over 3 cm have a more severe impact on ovarian performance during COH [24].…”

Section: In Vitro Fertilizationmentioning

confidence: 81%

Treatment of Endometriosis in Women Desiring Fertility

Mavrelos

Sarıdoğan

2015

J Obstet Gynecol India

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Endometriosis is a common condition affecting a significant proportion of women in their reproductive age. Apart from the impact of endometriosis on the quality of life of these patients, it also can have an impact on the potential of these women to have a family. The options for treating women with endometriosis desiring a family include surgery or assisted reproduction techniques. The choice of treatment will depend on the stage of disease and the characteristics of the couple seeking help. We review here the latest evidence on the management of endometriosis in women desiring fertility and describe our current practice.

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“…Ancak randomize kontrollü çalışmalar YÜT öncesi cerrahinin, başarı şansını arttırmadığını göstermiştir. [19][20][21] Ayrıca cerrahi yapılan kadınlarda, cerrahi yapıl-mayanlara göre stimülasyon daha uzun sürmekte, daha fazla gonadotropin gerektirmekte ve de toplanan oosit sayısı daha az olmaktadır. 20 Bu yüzden bu kadınlarda cerrahi, sadece overlere ulaşılamadı-ğında ya da ağrı tedavisi için düşünülmelidir.…”

Section: Yardimci üReme Tekni̇kleri̇ (Yüt)unclassified

Management of Infertility in Women with Endometriosis

Sarıdoğan¹,

Saridogan²

2017

TJRMS

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ndometriozis, infertil kadınlarda sıklıkla karşılaştığımız bir durumdur ancak endometriozisle infertilite arasındaki bağlantı hala tartışmalıdır. Laparoskopi, yüksek rezolüsyonlu ultrasonografi ve manyetik rezonans görüntüleme gibi kullanılan tanısal yöntemlerin zaman içinde gelişimi, tetkik edilen endometriozis tipini giderek değiştirmiştir. Bunun yanında, laparoskopik cerrahi ve yardımcı üreme tekniklerindeki gelişmeler de kullanılan tedavi yaklaşımlarını giderek değiştirmekte, bazen bu değişimin hızı Endometriozisin gelecekte infertilite riskini artırdığına dair ikna edici birçok kanıt vardır. Erken evre endometrioziste azalmış fertilitenin patogenezi tam olarak bilinmemekle birlikte evre III ve IV endometriozisteki pelvik anatomi distorsiyonunun infertiliteden sorumlu olduğu düşünülmektedir. Hem erken ve hem de ileri evre endometriozis için yapılan laparoskopik cerrahi spontan gebelik oranlarını iyileştirmekte yararlıdır. Açıklanamayan infertilitesi olanlar dışındaki iyi over rezervli genç kadınlarda cerrahi ilk seçenek olabilir. Erkek faktör infertilitesi veya tubal hasar birlikteliği ya da diğer yaklaşımların başarısızlığı söz konusu olduğunda endometriozis ilişkili subfertilitede yardımcı üreme teknikleri tercih edilecek tedavidir. Diğer tanısal kategorilere kıyasla endometriozisli kadınlarda yardımcı üreme tekniklerinin klinik gebelik oranları daha düşük görünse de, geniş ulusal veritabanlarından alınan verilerin sonuçları bunun aksini göstermektedir.A An na ah h t ta ar r K Ke e l li i m me e l le er r: : Endometriozis; infertilite; yönetim A AB BS S T TR RA AC CT TThere is convincing evidence that endometriosis increases future risk of infertility. The pathogenesis of reduced fertility in early endometriosis is not clearly known but distortion to pelvic anatomy in stage III and IV endometriosis is likely to be responsible for infertility. Laparoscopic surgery for both early and advanced endometriosis is beneficial in improving spontaneous conception rates. Surgery may be the first choice in young women with good ovarian reserve and otherwise unexplained infertility. However, assisted reproductive technology (ART) is the preferred treatment in endometriosis associated subfertility when there is concomitant male factor infertility or tubal damage or when other approaches have failed. Clinical pregnancy rates of ART may be lower in women with endometriosis compared to other diagnostic categories, however this is disputed on the basis of data from large national databases. ART does not appear to increase the risk of recurrent endometriosis. Ya zış ma Ad re si/Cor res pon den ce:

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Effect of endometrioma cystectomy on IVF outcome: a prospective randomized study

Cited by 137 publications

References 35 publications

National survey of the current management of endometriomas in women undergoing assisted reproductive treatment

National survey of the current management of endometriomas in women undergoing assisted reproductive treatment

Treatment of Endometriosis in Women Desiring Fertility

Management of Infertility in Women with Endometriosis

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