Ovarian cyst aspiration prior to in vitro fertilization treatment for subfertility

McDonnell, Rose; Marjoribanks, Jane; Hart, Roger

doi:10.1002/14651858.cd005999.pub2

Cited by 17 publications

(11 citation statements)

References 20 publications

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“…A total of 17-44% of infertile patients with endometriosis are diagnosed with ovarian endometrioma (Vercellini et al, 2003). Surgical excision, cyst aspiration, hormonal treatment, ethanol injection as well as leaving the cysts in situ are management options of endometrioma in infertile women (Beretta et al, 1998;Brown and Farquhar, 2014;McDonnell et al, 2014;Garcia-Tejedor et al, 2015). Yet, optimal management is still controversial.…”

Section: Introductionmentioning

confidence: 99%

Which is worse? A comparison of ART outcome between women with primary or recurrent endometriomas

et al. 2017

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Are live birth rates (LBR) different after ART cycles between women with primary or recurrent endometrioma? SUMMARY ANSWER: Women with recurrent endometrioma have similar LBR as compared to patients with primary endometrioma. WHAT IS ALREADY KNOWN: Recurrence rate can be as high as 29% after endometrioma excision. Prior studies on management of endometrioma before ART involve primary endometriomas. There is limited information regarding the prognosis of women with recurrent endometriomas. STUDY DESIGN, SIZE, DURATION: A multicenter retrospective cohort study, including 76 women with primary and 82 women with recurrent endometriomas treated at the participating centers over a 6-year period. PARTICIPANTS/MATERIALS, SETTING, METHODS: Women with endometrioma who underwent ART at three academic ART centers. Couples with another indication for ART were excluded. MAIN RESULTS AND THE ROLE OF CHANCE: Female age, median number of prior failed ART cycles, proportion of patients with bilateral endometrioma (28 versus 28.9%), ovarian stimulation protocols, and total gonadotropin consumption were similar between the study groups. Numbers of metaphase two oocytes (5 versus 6), number of embryos transferred, and the proportion of patients undergoing blastocyst transfer were similar across the study groups. Clinical pregnancy rates (36.6 versus 34.2%, absolute difference 2.4%, 95% CI: −12.5 to 17.3%, P = 0.83) and LBR (35.4 versus 30.3%, absolute difference 5.1%, 95% CI: −9.5 to 19.7%, P = 0.51) per started cycle in recurrent and primary endometrioma were similar. Comparable success rates were also confirmed with logistic regression analysis (OR: 1.14, 95% CI: 0.78-0.57, P = 2.3) LIMITATIONS, REASONS FOR CAUTION: The retrospective design has inherent limitations. Some women with severely decreased ovarian reserve after primary endometrioma excision may not have pursued further treatment. WIDER IMPLICATIONS OF THE FINDINGS: The management of endometrioma prior to ART is controversial but a different management strategy is not required for recurrent endometriomas. Since recurrent endometriomas do not have a worse impact on ART outcome than primary endometriomas, and repeat surgery has a higher risk for complications, conservative management without surgery can be justified. STUDY FUNDING/COMPETING INTEREST(S): No funding or competing interests to declare. TRIAL REGISTRATION NUMBER: None.

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Section: Introductionmentioning

confidence: 99%

Which is worse? A comparison of ART outcome between women with primary or recurrent endometriomas

et al. 2017

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“…They concluded that there is insufficient evidence to determine whether drainage of functional ovarian cysts prior to controlled ovarian hyperstimulation (COH) influences clinical pregnancy rate, live birth rate, the number of follicles recruited, or oocytes collected in women with an ovarian cyst. The conclusions of this review do not provide supportive evidence for this approach, especially in view of the requirement for anesthesia, extra cost, psychological distress and the risk of surgical complications (81).…”

Section: Risk Of Conservative Management Of Endometrioma Before Ivfmentioning

confidence: 82%

Management of Endometriomas Prior to IVF

Maiorana¹,

Incandela²,

Mercurio³

et al. 2017

Journal of Endometriosis and Pelvic Pain Disorders

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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).

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“…The effect of functional ovarian cysts on clinical outcomes after 258 GnRH-a usage is controversial. There is insufficient evidence to determine whether drainage of 259 functional ovarian cysts prior to controlled ovarian hyperstimulation negatively influenced live 260 birth rate, clinical pregnancy rate, number of follicles recruited, or oocytes collected in women 261 with a functional ovarian cyst [McDonnell, Marjoribanks & Hart, 2014]. In this research, the 262 formation rate of functional ovarian cysts was much lower than that of nonfunctional cysts.…”

mentioning

confidence: 74%

“…The pathophysiological mechanism of cyst formation is unknown so 235 far. However, possible mechanisms have been published [Feldberg et al, 1989; Pereira et al, 236 2016;McDonnell et al, 2014]. It is easy for ovarian cysts to form when initiated at the follicular 237 phase, especially in women with higher basal FSH levels during their menstrual cycle.…”

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confidence: 99%

Peer Review #4 of "Prolonged pituitary down-regulation with full-dose of gonadotropin-releasing hormone agonist in different menstrual cycles: a retrospective cohort study (v0.2)"

2019

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Background:The efficiency of prolonged down-regulation caused by a full-dose of gonadotropin-releasing hormone agonist (GnRH-a) injected during different menstrual phases has not yet been researched. Our goal was to evaluate the effects of GnRH-a, which was used in different phases of the menstrual cycle in patients undergoing in vitro fertilization and embryo transfer (IVF-ET). Methods: This was a retrospective cohort study.Three hundred and twenty patients received a prolonged pituitary down-regulated fulldose (3.75mg) of triptorelin in the early follicular phase, and 160 patients received the same full-dose of triptorelin during the mid-luteal phase. Clinical and laboratory outcomes were compared between the two groups. Results: The basic characteristics of the two groups were comparable. The mean number of retrieved oocytes, fertilized oocytes, cleavage oocytes and good quality embryos were comparable between the two groups.Although there was a higher antral follicle count (AFC), cyst formation rate, fertilization rate and cleavage rate in the follicular phase group, no statistically significant effects were seen on implantation rate (41.15% vs. 45.91%), clinical pregnancy rate (60.38% vs. 61.36%), ongoing pregnancy rate (57.74% vs. 57.58%), live birth rate (56.23% vs. 57.58%) or early abortion rate (2.64% vs. 3.79%) per fresh transfer cycle. Moreover, severe ovarian hyper-stimulation syndrome (OHSS) rates at the early stage (1.89% vs. 2.27%) were low in both groups. Conclusions: Prolonged pituitary down-regulation achieved by utilizing a full-dose of GnRH-a administrated in either phase of the menstrual cycle can have a positive effect on ongoing pregnancy rate and live-birth rate per fresh embryo transfer cycle. Ovarian cyst formation rate was higher in the follicular phase group, but this did not have any adverse impact on clinical results. PeerJ reviewing PDF | 28 29 30 ABSTRACT 31 Background: The efficiency of prolonged down-regulation caused by a full-dose of 32 gonadotropin-releasing hormone agonist (GnRH-a) injected during different menstrual phases 33 has not yet been researched. Our goal was to evaluate the effects of GnRH-a, which was used in 34 different phases of the menstrual cycle in patients undergoing in vitro fertilization and embryo 35 transfer (IVF-ET). 36 Methods: This was a retrospective cohort study. Three hundred and twenty patients received a 37 prolonged pituitary down-regulated full-dose (3.75mg) of triptorelin in the early follicular phase, PeerJ reviewing PDF | Manuscript to be reviewed 38 and 160 patients received the same full-dose of triptorelin during the mid-luteal phase. Clinical 39 and laboratory outcomes were compared between the two groups. 40 Results: The basic characteristics of the two groups were comparable. The mean number of 41 retrieved oocytes, fertilized oocytes, cleavage oocytes and good quality embryos were 42 comparable between the two groups. Although there was a higher antral follicle count (AFC), 43 cyst formation rate, fertilization rate and cleavage rate ...

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Ovarian cyst aspiration prior to in vitro fertilization treatment for subfertility

Cited by 17 publications

References 20 publications

Which is worse? A comparison of ART outcome between women with primary or recurrent endometriomas

Which is worse? A comparison of ART outcome between women with primary or recurrent endometriomas

Management of Endometriomas Prior to IVF

Peer Review #4 of "Prolonged pituitary down-regulation with full-dose of gonadotropin-releasing hormone agonist in different menstrual cycles: a retrospective cohort study (v0.2)"

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