Management of Endometriomas Prior to IVF

Abstract

between 0.02 and 0.10 per month. The fecundity rate in women with stage III/IV endometriosis is 2% to 10%, compared with 15% to 25% in control subjects (4, 5). The hallmarks of endometriosis are endometriomas (endometriotic cysts), peritoneal endometrial implants, adhesions and deep infiltrating endometriosis. The lesions are the cause of chronic pelvic pain, dysmenorrhea, dyschezia, dyspareunia, and urinary symptoms, and they can be associated with infertility. Usual clinical examination is insufficient to diagnose and evaluate the extent of deep pelvic endometriosis (6). Pelvic endometriosis can be estimated by means of various imaging techniques, including transvaginal sonography (TVS), transrectal sonography (TRS), rectal endoscopic sonography (RES), and magnetic resonance imaging (MRI). TVS is the first-line diagnostic technique, owing to its accessibility and relatively high accuracy. By local reactions, space-occupying effects, or both, cysts can reduce the amount of functional ovarian tissue available, which could be aggravated further by surgery (7). Although the best surgical approach to endometriomas is uncertain, it is well demonstrated that any type of surgery could cause additional damage to already compromised ovarian function (8). Furthermore, the decline in ovarian follicles that happens throughout life does not greatly hamper the chance of conception before 37 years of age. However, this deterioration can take place at an earlier age in cases of ovarian endometriosis (9).