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

Abstract

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.

Effect of Endometrioma cystectomy on cytokines of follicular fluid and IVF outcomes

“…In addition, several studies have found that surgical removal of endometriotic lesions prior to ART treatment does not improve reproductive outcomes, but rather decreases the ovarian reserve [29, 30]. For example, Ata et al (2017) found that women with endometriomas had a lower ovarian reserve than age-matched controls, and this reserve was further reduced by surgical excision of endometriomas [31]. Several studies have since confirmed that the ovarian reserve damage and the IVF response after surgery was related to the size of the ovarian cysts and the presence of bilateral endometrioma [32–35].…”

Do endometriomas grow during ovarian stimulation for assisted reproduction? A three-dimensional volume analysis before and after ovarian stimulation

“…The lack of a histologic diagnosis of endometriomas can be regarded as a limitation of the present study. As surgical excision is associated with a further decrease in ovarian reserve and does not seem to improve assisted reproduction technique outcome (Ata and Uncu, 2015;Ata et al, 2017;Hamdan et al, 2015;Somigliana et al, 2012), current indications for surgery are rather limited. These include pain unresponsive to medical treatment, organ involvement, e.g.…”

“…The presence of the cyst was confirmed at least on two separate examinations carried out at least one month apart to rule out other haemorrhagic cysts that could be confused with an endometrioma (Exacoustos et al, 2014;Savelli, 2009). Ovarian stimulation protocols are defined elsewhere (Ata et al, 2017). Briefly, the long gonadotrophin releasing hormone (GnRH) agonist involved daily subcutaneous injections of 0.5 mg leuprolide acetate (Lucrin Daily, Abbot), starting from the mid-luteal phase of the preceding cycle until the day of ovulation trigger.…”

Assisted reproductive treatment outcomes of women with endometriomas: Either with or without previous ovarian surgery

“…In their retrospective study, the number of dominant follicles was significantly higher in the operated ovaries with recurrence than without recurrence. 6 In line with this view, second-line surgery for recurrent endometriomas has been associated with decreased ovarian reserve [24][25][26][27][28] as well as decreased ovarian response and clinical pregnancy rates after ART cycles. 29 Our study found similar rates of ovarian response and live birth following ART cycles in women with recurrent and primary endometriomas.…”