The effect of surgical management of endometrioma on the IVF/ICSI outcomes when compared with no treatment? A systematic review and meta-analysis

Abstract

ObjectiveTo assess the impact of surgical management of endometrioma on the outcome of assisted reproduction treatment (ART).DesignA systematic review and meta-analysis.SettingDepartment of reproductive medicine at teaching university hospital, UK.PatientsSubfertile women with endometrioma undergoing ART.InterventionsSurgical removal of endometrioma or expectant management.Main outcome measuresClinical pregnancy rate, pregnancy rate, live birth rate, number of oocytes retrieved and number of embryos available and ovarian response to gonadotrophins.ResultsAn extensive search of electronic databases for articles published from inception to September 2016 yielded 11 eligible studies for meta-analysis. Meta-analysis was conducted comparing surgery versus no treatment of endometrioma. There were no significant differences in pregnancy rate per cycle, clinical pregnancy rate and live birth rate between women who underwent surgery for endometrioma and those who did not.ConclusionCurrent evidence suggests that women with endometriosis-related infertility have similar cycle outcomes to other patients going through ART. It is pertinent for clinicians to assess the risks of surgical intervention on ovarian reserve prior to initiating therapy.

Effect of endometrioma and its surgical excision on fertility (Review)

“…Surgical excision may increase the possibility to achieve pregnancy by restoring the anatomy of the affected ovaries in patients with endometrioma (46). However, pre-cycle surgical treatment of endometrioma does not appear to increase pregnancy rates in ART, along with a further detrimental impact on ovarian reserve (76)(77)(78)(79)(80). Considering the insufficient evidence favoring surgical excision before ART, cystectomy should only be suggested in specific situations, such as suspicious features, progressive symptoms and large cysts (87).…”

“…Extensive evidence indicated that surgery for OMA may cause damage on ovarian reserve (37)(38)(39). Moreover, much evidence (76)(77)(78) suggests that surgery for OMA has an adverse effect on ovarian response, with a reported reduction of oocytes retrieved following surgery. Recently, a meta-analysis including 28 studies investigated whether pre-ART cystectomy improved fertility, and no evidence showed any benefit of surgery, instead reporting similar CPR rates and LBR between females having undergone surgery for endometriomas and those who did not (76).…”

“…Moreover, much evidence (76)(77)(78) suggests that surgery for OMA has an adverse effect on ovarian response, with a reported reduction of oocytes retrieved following surgery. Recently, a meta-analysis including 28 studies investigated whether pre-ART cystectomy improved fertility, and no evidence showed any benefit of surgery, instead reporting similar CPR rates and LBR between females having undergone surgery for endometriomas and those who did not (76). Additionally, evidence from other studies demonstrated that females having undergone surgery for endometrioma before in vitro fertilization (IVF) or intracytoplasmic sperm injection exhibited similar fertility results compared with controls (77)(78)(79)(80).…”

Letter to the editor

“…agement of endometrioma on the IVF/ICSI outcomes when compared with no treatment? A systematic review and metaanalysis" [1]. It was written by M. Nickkho-Amiry as the lead author and published in your journal.…”

Advisory Board Resolution on the subject: 'Possibilities of personalized hormone-based therapies for endometriosis using dydrogesterone / Approval of the protocol of an Observational Open-Label Multicenter Study of Real Clinical Practice to Evaluate the Effects of Hormonal therapy with Oral Dydrogesterone for Treatment of Confirmed Endometriosis (the ORCHIDEA study)'

“…Дидрогестерон не подавляет овуляцию, поэтому может быть назначен женщинам, планирующим беременность, при этом вероятность наступления беременности у женщин с эндометриоз-ассоциированным бесплодием повышается [1, [10][11][12][13]. Препарат доказанно снижает риск спорадического и привычного самопроизвольного патологического прерывания беременности при недостаточности лютеиновой фазы, его прием целесообразен во время беременности, так как при эндометриозе риск самопроизвольного патологического прерывания беременности повышен в 1,7-3 раза (диеногест противопоказан во время гестации) [7, [14][15][16][17][18].…”