Weigh the pros and cons to ovarian reserve before stripping ovarian endometriomas prior to IVF/ICSI: A meta-analysis

Abstract

PurposeTo explore the effects of conservative surgery for endometriomas on ovarian responsiveness during assisted reproductive technology (ART) and provide reproductive and gynecological doctors with a more reliable reference program for the treatment of endometriomas.MethodsA literature search was performed by searching the PubMed, Embase, Cochrane Library, Web of Science and Science Direct databases. Studies with inter- and intra-patient comparisons of ovarian responses and oocyte quality between operated and unoperated ovaries and that met the inclusion criteria were retrieved, and the data from the outcome measures were extracted and pooled for this meta-analysis.ResultsTwenty-one published studies (2649 ART cycles) were included. The total amount of gonadotropin (Gn) used (inverse variance (IV):0.48; 95% confidence interval (CI): [0.13, 1.82], P = 0.0007) was significantly increased in the women with endometriomas who had a history of cystectomy. The estrogen (E) level on the day of hCG administration (IV: -0.29; 95% CI: [-0.41, -0.17], P<0.00001), the number of mature or dominant follicles (IV: -1.17; 95% CI: [-1.51, -0.82], P<0.00001) and the total number of oocytes retrieved (IV: -1.78; 95% CI: [-2.38, -1.17], P<0.00001) were significantly decreased in the women with endometriomas who had a history of cystectomy. The duration of stimulation (IV: 0.02; 95% CI: [-0.09, 0.13], P = 0.77), the total number of formed embryos (IV: -0.06; 95% CI: [-0.17, 0.04], P = 0.25), the pregnancy rate(IV:0.98;95%CI[0.82,1.18], P = 0.83) and the live birth rate(IV:0.93;95%CI[0.70,1.23], P = 0.61)were not statistically different between the two groups. Similar intra-patient results were found in the number of mature or dominant follicles (IV: -0.88; 95% CI: [-1.25, -0.52], P<0.00001) and the total number of oocytes retrieved (IV: -3.48; 95% CI: [-4.77, -2.19], P<0.00001).ConclusionART might be a better therapeutic method for ovarian endometrioma-related infertility than cystectomy.

Analysis of IVF/ICSI-FET Outcomes in Women With Advanced Endometriosis: Influence on Ovarian Response and Oocyte Competence

“…Surgical excision may have a greater impact on ovarian response according to the results of this study. Although there was no significant difference in AFC and the proportion of POR, the number of dominant follicles, number of oocytes retrieved, number of mature oocytes retrieved, and number of viable embryos in the cystectomy group were significantly fewer than those of the aspiration group, similar to the results of Tao et al ( 56 ). The number of viable embryos determines the chances of transfer, and its reduction means lower probability of pregnancy.…”

Could surgical management improve the IVF outcomes in infertile women with endometrioma?: a review

“…Xing et al [40] reported in a recent retrospective study that the number of MII oocytes collected during IVF cycles was significantly lower in women who had previously undergone a laparoscopic endometrioma cystectomy than in women with pelvic endometriosis. In three recently published meta-analyses that compared patients with and patients without surgery for endometrioma, the numbers of total oocytes and MII oocytes collected during IVF cycles were significantly lower in the surgery group than in the no surgery group, but no significant differences were observed between the two groups in terms of live birth and clinical pregnancy rates [234142]. The results suggested that surgical intervention for endometrioma failed to improve reproductive outcomes in IVF cycles (Table 1).…”

Endometriosis and oocytes (a review)

“…Частота его встречаемости среди пациенток, страдающих бесплодием, составляет до 35-50% [3]. Данная патология широко распространена, в том числе среди женщин репродуктивного возраста (до 15%) [19,21]. Эндометриоз -заболевание женской репродуктивной системы, при котором эндометрий разрастается за пределами матки.…”