Is there a benefit for surgery in endometrioma-associated infertility?

Abstract

Laparoscopic surgery for the removal of endometriomas is still a very common practice in the field of reproductive medicine. Although endometriomas per se may be detrimental to the ovarian reserve, the current evidence points toward an even lower ovarian reserve after surgery. Additionally, a reduced response of the ovaries to gonadotrophins has been described in different studies after surgical removal of endometriomas. The quality of the oocytes retrieved in IVF cycles is not improved after surgery. Patients going through an operative procedure might extend the time to pregnancy. Surgery should be envisaged only in specific circumstances such as pelvic pain or difficult access to growing follicles but not offered to every single patient with endometrioma-associated infertility.

Surgical treatment of ovarian endometriomas: state of the art?

“…Many publications have cast doubt on the beneficial effect of surgical treatment of endometriomas on fertility, and indeed they have raised increasing concerns about the deleterious effect of surgery on the ovarian reserve and the higher risk of premature ovarian failure (17,18). These concerns are based on three types of studies: studies analyzing histologic samples of endometriomas removed by surgery-and, more specifically, the presence of follicles in these samples; those analyzing outcomes of IVF procedures in women after surgical removal of endometriomas; and those comparing the markers of ovarian reserve in women before and after surgical treatment of endometriomas.…”

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

“…Moreover, the excision of endometriomas can improve the success rate of ART[3]. However, 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[4–7]. 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].…”

Deep infiltrating endometriosis affecting the urinary tract—surgical treatment and fertility outcomes in 2004–2013

“…According to the ESHRE guidelines, there is not enough evidence to propose surgery before ART [11]. In addition, there are conflicting results on impact of endometriosis on infertility: presence of endometrioma may [12] or may not [13, 14] reduce ovarian reserve and even the presence of DIE may have an impact on ovarian function [15, 16]. On the other hand, surgery of ovarian endometrioma may [17] or may not [18] have a negative impact on ovarian reserve, and surgery of DIE may [19, 20] or may not improve fertility [21, 22].…”