Is there a critical endometrioma size associated with reduced ovarian responsiveness in assisted reproduction techniques?

Abstract

This study investigated the relationships between ovarian endometrioma size, ovarian responsiveness and the number of retrieved oocytes following ovarian stimulation. A prospective study was conducted in a public clinical assisted reproduction centre. A total of 64 infertile women with monolateral endometriomas undergoing IVF or intracytoplasmic sperm injection were included in the study. The total number of follicles, number of follicles ≥ 16 mm and number of oocytes retrieved of ovaries containing endometrioma and normal ovaries were compared. Multivariate linear regression was used to assess whether number of follicles and collected oocytes varied by endometrioma size, age, basal FSH concentration. Significantly lower numbers of follicles ≥ 16 mm (P = 0.024) and oocytes retrieved (P = 0.001) in the ovaries containing endometrioma were observed. In patients with endometriomas ≥ 30 mm, endometrioma size was the most influential contributor to the total number of follicles and oocytes retrieved. Ovarian endometriomas result in reduced response to ovarian stimulation, compared with the response of the contralateral normal ovary in the same individual. In case of endometriomas <30 mm, basal FSH concentration remains the most important prognostic factor for oocyte retrieval.

Pregnancy outcomes after assisted reproductive procedures with embryos that had been derived from affected and unaffected ovaries among women with small unilateral endometriomas

“…The management of endometriomas that are <40 mm in size in women who attempt to conceive remains a matter of debate 5, 13, 14, 15. The results of this study demonstrated that the AFC, the number of follicular flushings, the number of retrieved oocytes, and the number of obtained embryos were all significantly lower for the endometrioma‐containing ovary than for the contralateral, intact ovary.…”

“…Another study also reported that the presence of an endometrioma resulted in a reduced response to ovarian stimulation, compared with the response of the contralateral, intact ovary in the same individual. It also was found that, in the case of endometriomas that are <30 mm, the basal FSH concentration is the most important prognostic factor for oocyte retrieval 14. In contrast, it has been reported that the presence of an endometrioma is not associated with a reduction in the number of retrieved oocytes 16.…”

“…The findings of this study were unique, in that the average age was relatively higher than that in similar studies. Other studies also were limited to patients who were younger than 40 years of age at the time of the IVF/ICSI cycle 5, 14. The patients who receive IVF/ICSI in Japan tend to be older.…”

The Impact of Ovarian Endometrioma(s) on ART Outcomes: Retrospective Case Control Study

“…According to the ESHRE guidelines, laparoscopic surgery before IVF/ICSI is considered to be the 'gold standard' in the treatment of symptomatic endometriomas (12). On the other hand, surgery indeed has a detrimental impact on ovarian reserve in terms of serum AMH levels and overall response to OS (15)(16)(17), despite enough surgical experience (26)(27)(28). In this context, size of the endometrioma seems to be the crucial determinant in management.…”

Treatment of Endometriosis in Women Desiring Fertility

“…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]. Moreover, such large endometriomas may restrict vaginal access to the ovary during retrieval.…”