Fertility Outcome after CO2 Laser Vaporization versus Cystectomy in Women with Ovarian Endometrioma: A Comparative Study

Abstract

To assess the postoperative likelihood of conception in patients with endometriomas managed by either CO 2 laser vaporization or cystectomy. Design: A retrospective study with prospective recording of data. Setting: University hospital. Patients: One hundred and forty-two patients with symptomatic endometriomas. Interventions: Patients underwent a standardized laparoscopic stripping technique (Group 1) or cyst vaporization with CO 2 fiber laser (Group 2). Patients wishing to become pregnant were allowed to attempt a spontaneous conception after surgery. If spontaneous conception failed, patients were referred for in vitro fertilization (IVF). Measurements and Main Results: The primary objective was to compare pregnancy rates between the 2 groups. The secondary objective was the identification of independent predictors of pregnancy. Thirty-nine women in Group 1 (53.4%) and 39 women in Group 2 (56.5%) desired to conceive after surgery. Three patients (7.7%) in Group 1 became pregnant following donor-IVF and were excluded. Pregnancies were recorded in 72.2% of patients treated with cystectomy and in 74.3% of those managed with CO 2 fiber laser (p = .83). Twenty patients (55.6%) in Group 1 and 14 patients (35.9%) in Group 2 conceived spontaneously (p = .08). Among patients who failed spontaneous conception, 21 patients (28%) achieved pregnancy through IVF (Group 1: n = 6, 16.7%; Group 2: n = 15, 38.5%; p = .08). Twenty patients (26.7%) never became pregnant. Age at the time of surgery (odds ratio (OR) = 0.86; 95% Confidence intervals (CI): 0.78−0.96, p = .002) and duration of infertility (OR=0.80; 95% CI: 0.69−0.92, p = .006) were identified as independent indicators for pregnancy. Conclusion: CO 2 laser-treated endometrioma is associated with pregnancy rates equal to those observed after cystectomy and favorable IVF outcomes. The one step CO 2 fiber laser technique may represent a viable alternative to cystectomy. Journal of Minimally Invasive Gynecology (2021) 28, 34−41.

Pregnancy rate following endometriomas management by ablation using plasma energy, cystectomy and drainage: A three‐arm comparative study

“…[3][4][5] Data about endometrioma ablation using energies with limited depth thermal spread such as CO 2 laser and plasma energy reported good results in terms of postoperative pregnancy rates and recurrence risk. [6][7][8][9][10][11] We also previously reported comparable pregnancy rates in a case series of women managed by either ablation using plasma energy or cystectomy, but with significant differences in endometriosis severity. 12 Although it has been demonstrated that endometrioma drainage is associated with short-term recurrences, the goal to protect the ovarian reserve justifies the choice of drainage.…”

“…19,21 Pregnancy rates in studies comparing women managed by either cystectomy or ablation using CO 2 laser varied from, respectively, 38.1% and 44.4% at 5 years after the surgery 22 to, respectively, 72.2% and 74.3% after a mean follow up averaging 3 years. 10 Case series including women undergoing ovarian ablation by plasma energy and getting pregnant in up to 73% of cases were reported by our team, and this study population may partially overlap with the one included in this study. 23,24 We should emphasize that a majority of women managed by ablation and simple drainage underwent surgical procedures for deep endometriosis involving the digestive tract.…”

Surgery versus IVF for the treatment of infertility associated to ovarian and deep endometriosis (SVIDOE: Surgery Versus IVF for Deep and Ovarian Endometriosis). Clinical protocol for a multicenter randomized controlled trial

“…Pre-procedure aspiration of the endometrioma is not part of the local policies of the participating centers and will not be performed. Surgery will be achieved according to local standards [ 5 , 6 , 19 ]. No efforts were done to standardize the surgical modalities.…”

“…Surgery aims at increasing the chances of natural conception and has the beneficial effect of relieving symptoms [ 6 , 7 ]. Among uncontrolled studies, the overall mean pregnancy rate is nearly 50% [ 8 ].…”

Minimally invasive surgery for ovarian endometriosis as a mean of improving fertility: Cystectomy vs. CO2 fiber laser ablation what do we know so far?

“…In our daily practice, we have introduced ablation using CO2 fiber laser technology: it is simple, easy to use, and has the advantage of eliminating the “surgeon's experience” factor ( 13 ). We have already been able to report encouraging results in terms of ovarian reserve preservation, postoperative pregnancy rates, recurrence risk and ovarian responsiveness in ART ( 14 – 16 ).…”