The effects of endometrioma size and bilaterality on ovarian reserve

Karadağ, Cihan; Yoldemir, Tevfik; Demircan, Sinem; Turgut, Abdülkadir

doi:10.1080/01443615.2019.1633518

Cited by 23 publications

(18 citation statements)

References 29 publications

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“…Maneschi [42] also reported on a decreased number of follicles in histological sections of the ovarian cortex surrounding the endometrioma, and proposed that the endometrioma may per se damage the ovary. Some studies suggested that the increase in size of the endometriomas could negatively adverse the ovarian reserve [43,44], while others have shown size to have no effect [45,46]. The discrepancy between studies may be related to the effect that size may have on the decision to surgically interfere, with a Fig.…”

Section: Discussionmentioning

confidence: 99%

The impact of endometrioma on in vitro fertilisation/intra-cytoplasmic injection IVF/ICSI reproductive outcomes: a systematic review and meta-analysis

Alshehre

Narice

Fenwick

et al. 2020

Arch Gynecol Obstet

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Background Assisted reproductive technologies (ART) such as in vitro fertilisation (IVF) and intra-cytoplasmic sperm injection (ICSI) are often used to aid fertility in women with endometrioma; however, the implications of endometrioma on ART are unresolved. Objective To determine the effect of endometrioma on reproductive outcomes in women undergoing IVF or ICSI. Methods A systematic review and meta-analysis was conducted to identify articles examining women who had endometrioma and had undergone IVF or ICSI. Electronic searches were performed in PubMed, BIOSIS and MEDLINE up to September 2019. The primary outcome was live birth rate (LBR). Secondary outcomes included clinical pregnancy rate (CPR), implantation rate (IR), number of oocytes retrieved, number of metaphase II (MII) oocytes retrieved, number of embryos and top-quality embryos and the duration of gonadotrophin stimulation and dose. Results Eight studies were included. Where significant heterogeneity between studies was identified, a random-effects model was used. The number of oocytes (weighted means difference; WMD-2.25; 95% CI 3.43 to − 1.06, p = 0.0002) and the number of MII oocytes retrieved (WMD-4.64; 95% CI 5.65 to − 3.63, p < 0.00001) were significantly lower in women with endometrioma versus controls. All other outcomes, including gonadotrophin dose and duration, the total number of embryos, high-quality embryos, CPR, IR and LBR were similar in women with and without endometrioma. Conclusion Even though women with endometriomas had a reduced number of oocytes and MII oocytes retrieved when compared to women without, no other differences in reproductive outcomes were identified. This implies that IVF/ICSI is a beneficial ART approach for women with endometrioma.

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Section: Discussionmentioning

confidence: 99%

The impact of endometrioma on in vitro fertilisation/intra-cytoplasmic injection IVF/ICSI reproductive outcomes: a systematic review and meta-analysis

Alshehre

Narice

Fenwick

et al. 2020

Arch Gynecol Obstet

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“…Indeed, several comparative studies ( 147 – 150 ) in patients with unilateral endometriomas undergoing IVF showed that the affected and the healthy ovary produce a similar number of codominant follicles and oocytes perhaps indicating more than a local effect in the affected ovary; a single visible endometrioma maybe a marker of bilateral disease or alternatively there may be a systemic effect of the single endometrioma on both ovaries. Women with bilateral endometriomas demonstrate an even lower response to stimulation, however clinical pregnancy rate are not affected ( 151 – 153 ), likely overcome by the availability of multiple eggs and embryos…”

Section: Pathophysiology Of Endometriosis Associated Infertilitymentioning

confidence: 99%

Endometriosis-associated infertility: From pathophysiology to tailored treatment

Bonavina

Taylor

2022

Front. Endocrinol.

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Despite the clinically recognized association between endometriosis and infertility, the mechanisms implicated in endometriosis-associated infertility are not fully understood. Endometriosis is a multifactorial and systemic disease that has pleiotropic direct and indirect effects on reproduction. A complex interaction between endometriosis subtype, pain, inflammation, altered pelvic anatomy, adhesions, disrupted ovarian reserve/function, and compromised endometrial receptivity as well as systemic effects of the disease define endometriosis-associated infertility. The population of infertile women with endometriosis is heterogeneous, and diverse patients’ phenotypes can be observed in the clinical setting, thus making difficult to establish a precise diagnosis and a single mechanism of endometriosis related infertility. Moreover, clinical management of infertility associated with endometriosis can be challenging due to this heterogeneity. Innovative non-invasive diagnostic tools are on the horizon that may allow us to target the specific dysfunctional alteration in the reproduction process. Currently the treatment should be individualized according to the clinical situation and to the suspected level of impairment. Here we review the etiology of endometriosis related infertility as well as current treatment options, including the roles of surgery and assisted reproductive technologies.

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“…Thus, the necessary of surgical resection of OMAs < 60 mm should be considered carefully. Karadag et al [ 31 ]discovered that increased OMA size is related to decreased AMH levels in patients with OMAs and bilateral OMAs have a more destructive effect on ovarian reserve. Moreover, OMAs (size < 60 mm) have no impact on embryo quality or final IVF outcomes (pregnancy and birth rates), despite a possible reduction in the number of oocytes retrieved and potentially higher Gn doses [ 32 ].…”

Section: Discussionmentioning

confidence: 99%

The presence of ovarian endometrioma adversely affect ovarian reserve and response to stimulation but not oocyte quality or IVF/ICSI outcomes: a retrospective cohort study

Zeng

et al. 2022

J Ovarian Res

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Background The possible impact of ovarian endometriomas (OMAs) on in vitro fertilization (IVF) outcomes remains controversial. Therefore, this study aimed to assess the impact of OMAs on IVF cycle parameters, including ovarian reserve and response to stimulation, embryo quality and pregnancy outcomes. Methods This retrospective cohort study included 2067 patients undergoing their first IVF/ICSI cycles between January 2018 and December 2020. The study group included 154 infertile women who had OMAs. The control group consisted of 1913 women without endometriosis, and finally 305 women were matched according to maternal age, body mass index (BMI), and infertility duration by propensity score matching (PSM). Cumulative live birth rate (CLBR) was set as the primary outcome measure. Logistic regression analysis was conducted on the basis of clinical covariates assessed for their association with CLBRs. Subgroup analyses were performed to evaluate the effect of ovarian surgery, cyst size and laterality on CLBRs. Results Women with OMAs had significantly lower ovarian reserve markers (AMH and AFC), number of follicles, oocytes, embryos, and top-quality embryos than women in the control group (p < 0.05). However, the CLBRs were comparable between the two groups (55.64% versus 54.34%, p = 0.806), regardless of previous history of ovarian surgery. Multivariate analysis revealed association between age (OR = 0.861; 95% CI [0.806–0.921]; p = 0.000), top-quality embryos (OR = 1.829; 95% CI [1.526–2.193]; p = 0.000) and the CLBRs. A negative correlation between OMA size and AFC levels in patients with unoperated OMAs was detected (r = -0.264, p = 0.007). Meanwhile, significant decrease in ovarian reserve with lower AFC, fewer oocytes, embryos and top-quality embryos were observed in patients with OMAs size ≥ 6 cm (p < 0.05). Moreover, ovaries with OMAs had a significantly lower AFC (P = 0.006) but similar number of oocytes when compared with contralateral ovaries without OMAs. Conclusion Infertile women with OMAs were implicated in considerable decreases in ovarian reserve and response to stimulation, but no apparent adverse effects on oocyte quality or clinical outcomes. OMAs surgery and OMAs size may adversely affect ovarian reserve, but not CLBR.

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The effects of endometrioma size and bilaterality on ovarian reserve

Cited by 23 publications

References 29 publications

The impact of endometrioma on in vitro fertilisation/intra-cytoplasmic injection IVF/ICSI reproductive outcomes: a systematic review and meta-analysis

The impact of endometrioma on in vitro fertilisation/intra-cytoplasmic injection IVF/ICSI reproductive outcomes: a systematic review and meta-analysis

Endometriosis-associated infertility: From pathophysiology to tailored treatment

The presence of ovarian endometrioma adversely affect ovarian reserve and response to stimulation but not oocyte quality or IVF/ICSI outcomes: a retrospective cohort study

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