Laparoscopic Ovarian Cystectomy versus Fenestration/Coagulation or Laser Vaporization for the Treatment of Endometriomas: A Meta-Analysis of Randomized Controlled Trials

Background/Aims: To analyze whether the presence of endometriosis per se is associated with inferior pregnancy rates in women undergoing in vitro fertilization (IVF). Methods: Between July 2005 and November 2012, a total of 485 patients with endometriosis under the age of 38 years undergoing their first IVF attempt at our center were included; 72 patients had minimal-mild disease and the remaining 413 patients had moderate-severe disease. 131 patients with laparoscopically confirmed tubal factor infertility not harboring endometriosis and hydrosalpinx under the age of 38 years undergoing their first IVF attempt at our center served as the control group. Results: The bilateral antral follicle count and controlled ovarian hyperstimulation response were diminished in the moderate-severe group. However, the implantation, clinical pregnancy, miscarriage and live birth rates were comparable among the three groups. The recurrence of endometrioma following pre-IVF cystectomy was not associated with inferior pregnancy rates. Female age, bilateral antral follicle count and number of embryos transferred were noted to be significant independent predictors of live birth. Conclusion: We conclude that neither the presence nor the extent of endometriosis have any detrimental effect on IVF pregnancy rates.

Section: Discussionmentioning

confidence: 51%

Endometriosis Is Not Associated with Inferior Pregnancy Rates in in vitro Fertilization: An Analysis of 616 Patients

Polat¹,

Boynukalın²,

Yaralı³

et al. 2014

“…Laparoscopic surgery is currently the first choice for the diagnosis and treatment of infertility in patients with endometriosis [6], although researchers have found some genes suitable for diagnostic quantitative RT-PCR for endometriosis in the peripheral blood [7,8]. A meta-analysis of two trials has demonstrated the advantage of laparoscopic surgery for early-stage endometriosis compared with diagnostic laparoscopy in regard to ongoing pregnancy at 20 weeks (odds ratio, 1.64; 95% confidence interval: 1.05-2.57) [9].…”

Section: Discussionmentioning

confidence: 99%

Reproductive Performance after Surgery for Endometriosis: Predictive Value of the Revised American Fertility Society Classification and the Endometriosis Fertility Index

Zeng¹,

Xu²,

Zhou³

et al. 2014

Background/Aims: To determine whether the revised American Fertility Society (rAFS) classification and endometriosis fertility index (EFI) predict pregnancy rates (PRs) in patients with surgically confirmed endometriosis attempting natural conception. Methods: We retrospectively assessed 194 women with endometriosis who underwent laparoscopic surgery; 161 women completed the follow-up. Pregnancy outcomes, rAFS stages and EFI scores were documented. Cumulative PRs were compared using Kaplan-Meier survival analysis. Results: The cumulative PR 36 months after surgery was 46.6% (stage I, 53.6%; stage II, 36.0%; stage III, 51.7%, and stage IV, 41.7%; log-rank test, χ² = 4.143, p = 0.246). In the 1st year, PRs significantly differed between patients with rAFS stage IV and those with stages I-III (Pearson's χ² test, χ² = 6.024, p = 0.014). Significant differences in cumulative PRs were observed among EFI scores (group 1, EFI score 0-3, 8.3%; group 2, EFI score 4-7 41.2%, and group 3, EFI score 8-10 60.9%; log-rank test, χ² = 16.254, p < 0.001). Conclusions: EFI scores, but not rAFS stage, predict PRs in patients with endometriosis-associated infertility. EFI scores may be used to guide postoperative treatment.

“…The current data suggest that cystectomy for endometrioma cannot prevent postoperative ovarian cancer. As for the surgical procedure for endometrioma, Dan and Limin [22] showed the results of a meta-analysis that cystectomy provided better outcomes than fenestration/coagulation or laser ablation regarding the recurrence of symptoms and endometrioma. In the 16 patients in whom cancer emerged after hormonal treatment, shown in table 2, ovarian cancer was not found during medical treatment.…”

Section: Discussionmentioning

confidence: 99%

Clinical Characteristics of Patients in Japan with Ovarian Cancer Presumably Arising from Ovarian Endometrioma

Taniguchi

Harada

Kobayashi

et al. 2014

Objective: To investigate the clinical features of patients in Japan with malignant transformation of ovarian endometrioma. Patients: Thirty-three patients diagnosed with ovarian cancer presumably arising from endometrioma were recruited retrospectively. These patients had been followed for at least 2 years after the ovarian endometrioma diagnosis, then continued to be followed after they had been found to have malignant transformation. Results: The average age of the patients was 47.7 ± 9.3 years; 75.7% were premenopausal at the time of diagnosis of ovarian cancer. Among the 33 patients, ovarian cancer developed in the ipsilateral ovary of 6 patients with endometrioma after cystectomy. Twenty-eight patients were diagnosed with stage I ovarian cancer, and major histotypes were clear cell in 23 cases and endometrioid in 8. Before surgery for cancer, mural nodules within the endometriomas were detected in 32 patients, and 1 patient had a small 3-mm nodule. In 30 patients, the diameter of the tumor doubled in size 6 months prior to the diagnosis of malignant transformation. The diameter of the endometrioma and the preoperative CA125 value did not significantly correlate. Conclusions: To detect malignant transformation of ovarian endometrioma early and precisely, the clinician should determine the existence of a mural nodule and assess the rapid growth of the endometrioma.