Top

Archives of Gynecology and Obstetrics

Published in:

Open Access 01-04-2018 | Gynecologic Endocrinology and Reproductive Medicine

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

Authors: M. Nickkho-Amiry, R. Savant, K. Majumder, E. Edi-O’sagie, M. Akhtar

Published in: Archives of Gynecology and Obstetrics | Issue 4/2018

Abstract

Objective

To assess the impact of surgical management of endometrioma on the outcome of assisted reproduction treatment (ART).

Design

A systematic review and meta-analysis.

Setting

Department of reproductive medicine at teaching university hospital, UK.

Patients

Subfertile women with endometrioma undergoing ART.

Interventions

Surgical removal of endometrioma or expectant management.

Main outcome measures

Clinical pregnancy rate, pregnancy rate, live birth rate, number of oocytes retrieved and number of embryos available and ovarian response to gonadotrophins.

Results

An 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.

Conclusion

Current 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.

Giudice LC, Kao LC (2004) Endometriosis. Lancet. 364(9447):1789–1799CrossRefPubMed

Kennedy S, Bergqvist A, Chapron C, D’Hooghe T, Dunselman G, Saridogan E et al (2005) ESHRE guideline on the diagnosis and management of endometriosis. Hum Reprod 20(10):2698–2704. https://doi.org/10.1093/humrep/dei135 CrossRefPubMed

Macer ML, Taylor HS (2012) Endometriosis and infertility: a review of the pathogenesis and treatment of endometriosis- associated infertility. Obstet Gynecol Clin North Am 39:535–549CrossRefPubMedPubMedCentral

Olivennes F (2003) Results of IVF in women with endometriosis. J Gynecol Obstet Biol Reprod (Paris) 32:S45–S47

Cahill DJ, Wardle PG, Harlow CR, Hull MG (1996) Effect of progestogen therapy on follicular development, related hormone concentrations and fertilization in vitro in unstimulated cycles and unexplained and endometriosis-associated infertility. Hum Reprod 11:647–650CrossRefPubMed

Khamsi F, Yavas Y, Lacanna IC, Roberge S, Endman M, Wong JC (2001) Exposure of human oocytes to endometrioma fluid does not alter fertilization or early embryo development. J Assist Reprod Genet 18:106–109CrossRefPubMedPubMedCentral

Dmowski WP, Rana N, Michalowska J, Friberg J, Papierniak C, el-Roeiy A (1995) The effect of endometriosis, its stage and activity, and of autoantibodies on in vitro fertilization and embryo transfer success rates. Fertil Steril 63:555–562CrossRefPubMed

Pellicer A, Valbuena D, Bauset C, Albert C, Bonilla-Musoles F, Remohi J et al (1998) The follicular endocrine environment in stimulated cycles of women with endometriosis: steroid levels and embryo quality. Fertil Steril 69:1135–1141CrossRefPubMed

Matalliotakis IM, Cakmak H, Mahutte N, Fragouli Y, Arici A, Sakkas D (2007) Women with advanced-stage endometriosis and previous surgery respond less well to gonadotropin stimulation, but have similar IVF implantation and delivery rates compared with women with tubal factor infertility. Fertil Steril 88:1568–1572CrossRefPubMed

10.

Hughesdon PE (1957) The structure of endometrial cysts of the ovary. J Obst Gynaecol Br Empire 64(4):481–487CrossRef

11.

Brosens I, Puttemans P, Gordts S, Campo R, Gordts S, Benagiano G (2013) Early stage management of ovarian endometrioma to prevent infertility. Facts Views Vis ObGyn 5(4):309–314PubMedPubMedCentral

12.

Alborzi S, Keramati P, Younesi M, Samsami A, Dadras N (2014) The impact of laparoscopic cystectomy on ovarian reserve in patients with unilateral and bilateral endometriomas. Fertil Steril 101(2):427–434CrossRefPubMed

13.

Garcia-Velasco A, Somigliana E (2009) Management of endometriomas in women requiring IVF: to touch or not to touch. Hum Reprod 24(3):496–501CrossRefPubMed

14.

Sanchez AM, Viganò P, Somigliana E, Panina-Bordigno P, Vercellini P, Candiani M (2014) The distinguishing cellular and molecular features of the endometriotic ovarian cyst: from pathophysiology to the potential endometrioma-mediated damage to the ovary. Human Reproduction Update 20(2):217–230CrossRefPubMed

15.

Pabuccu R, Onalan G, Goktolga U, Kucuk T, Orhon E, Ceyhan T (2004) Aspiration of ovarian endometriomas before intracytoplasmic sperm injection. Fertil Steril 82:705–711CrossRefPubMed

16.

Ragni G, Somigliana E, Benedetti F, Paffoni A, Vegetti W, Restelli L et al (2005) Damage to ovarian reserve associated with laparoscopic excision of endometriomas: a quantitative rather than a qualitative injury. Am J Obstet Gynecol 193:1908–1914CrossRefPubMed

17.

Marconi G, Vilela M, Quintana R, Sueldo C (2002) Laparoscopic ovarian cystectomy of endometriomas does not affect the ovarian response to gonadotrophin stimulation. Fertil Steril 78:876–878CrossRefPubMed

18.

Dong X, Wang R, Zheng Y, Xiong T, Lian X, Huang B, Zhang H (2014) Surgical treatment of endometrioma does not increase clinical pregnancy rate or live birth/ongoing pregnancy rate after fresh IVF/IVSI treatment. Am J Transl Res 6(2):163–168PubMedPubMedCentral

19.

Wong BC, Gillman NC, Oehninger S, Gibbons WE, Stadtmauer LA (2004) Results of in vitro fertilization in patients with endometriomas: is surgical removal beneficial? Am J Obstet Gynecol 191:598–607

20.

Pabuccu R, Onalan G, Kaya C (2007) GnRH agonist and antagonist protocols for stage I–II endometriosis and endometrioma in in vitro fertilization/intracytoplasmic sperm injection cycles. Fertil Steril 88:832–839CrossRefPubMed

21.

Suganuma N, Wakahara Y, Ishida D, Asano M, Kitagawa T, Katsumata Y et al (2002) Pretreatment for ovarian endometrial cyst before in vitro fertilization. Gynecol Obstet Invest 54(Suppl. 1):36–42CrossRefPubMed

22.

Takuma N, Sengoku K, Pan B, Wada K, Yamauchi T, Miyamoto T et al (2002) Laparoscopic treatment of endometrioma-associated infertility and pregnancy outcome. Gynecol Obstet Invest 54:30–35CrossRefPubMed

23.

Ho HY, Lee RK, Hwu YM, Lin MH, Su JT, Tsai YC (2002) Poor response of ovaries with endometrioma previously treated with cystectomy to controlled ovarian hyperstimulation. J Assist Reprod Genet 19:507–511CrossRefPubMedPubMedCentral

24.

Duru NK, Dede M, Acikel CH, Keskin U, Fidan U, Baser I (2007) Outcome of in vitro fertilization and ovarian response after endometrioma stripping at laparoscopy and laparotomy. J Reprod Med 52:805–809PubMed

25.

Wyns C, Donnez J (2003) Laser vaporization of ovarian endometriomas: the impact on the response to gonadotrophin stimulation. Gynecol Obstet Fertil 31:337–342CrossRefPubMed

26.

Somigliana E, Arnoldi M, Benaglia L, Iemmello R, Nicolosi AE, Ragni G (2008) IVF-ICSI outcome in women operated on for bilateral endometriomas. Hum Reprod 23(7):1526–1530CrossRefPubMed

27.

Bongioanni F, Revelli A, Gennarelli G, Guidetti D, Delle Piane LD, Holte J (2011) Ovarian endometriomas and IVF: a retrospective case-control study. Reprod Biol Endocrinol 17(9):81CrossRef

28.

Lee KH, Kim CH, Lee YJ, Kim SH, Chae HD, Kang BM (2014) Surgical resection or aspiration with ethanol sclerotherapy of endometrioma before in vitro fertilization in infertilie women with endometrioma. Obstet Gynecol Sci 57(4):297–303CrossRefPubMedPubMedCentral

29.

Garcia-Velasco JA, Mahutte NG, Corona J, Zuniga V, Giles J, Arici A et al (2004) Removal of endometriomas before in vitro fertilization does not improve fertility outcomes: a matched, case-control study. Fertil Steril 81:1194–1197CrossRefPubMed

30.

Tinkanen H, Kujansuu E (2000) In vitro fertilization in patients with ovarian endometriomas. Acta Obstet Gynecol Scand 79:119–122CrossRefPubMed

31.

Demirol A, Guven S, Baykal C, Gurgan T (2005) Effect of endometrioma cystectomy on IVF outcome: a prospective randomised study. Reprod Biomed Online 12:639–643CrossRef

32.

Harada M, Takahashi N, Hirata T, Koga K, Fujii T (2015) Osuga Y Laparoscopic excision of ovarian endometrioma does not exert a qualitative effect on ovarian function: insights from in vitro fertilization and single embryo transfer cycles. J Assist Reprod Genet 32(5):685–689CrossRefPubMedPubMedCentral

33.

Benaglia L, Bermejo A, Somigliana E, Scarduelli C, Ragni G, Fedele L, Garcia-Velasco JA (2012) 9. Pregnancy outcome in women with endometriomas achieving pregnancy through IVF. Hum Reprod. 27(6):1663–1667CrossRefPubMed

34.

Nakagawa K, Ohgi S, Kojima R, Sugawara K, Ito M, Horikawa T, Irahara M, Saito H (2007) Impact of laparoscopic cystectomy on fecundity of infertility patients with ovarian endometrioma. J Obstet Gynaecol Res 33(5):671–676CrossRefPubMed

35.

Shimizu Y, Takashima A, Takahashi K, Kita N, Fujiwara M, Murakami T (2010) Long-term outcome, including pregnancy rate, recurrence rate and ovarian reserve, after laparoscopic laser ablation surgery in infertile women with endometrioma. J Obstet Gynaecol Res 36(1):115–118CrossRefPubMed

36.

Benaglia L, Somigliana E, Vighi V, Ragni G, Vercellini P, Fedele L (2010) Rate of severe ovarian damage following surgery for endometriomas. Hum Reprod 25(3):678–682CrossRefPubMed

37.

Suzuki T, Izumi S, Matsubayashi H, Awaji H, Yoshikata K, Makino T (2005) Impact of ovarian endometrioma on oocytes and pregnancy outcome in in vitro fertilization. Fertil Steril 83(4):908–913CrossRefPubMed

38.

Oppenheimer A, Ballester M, Mathieu d’Argent E, Morcel K, Antoine JM, Daraï E (2013) Pregnancy rate after first intra cytoplasmic sperm injection—in vitro fertilisation cycle in patients with endometrioma with or without deep infiltrating endometriosis. Int J Fertil Steril 7(3):207–216PubMedPubMedCentral

39.

Ashrafi M, Fakheri T, Kiani K, Sadeghi M, Akhoond MR (2014) Impact of the endometrioma on ovarian response and pregnancy rate in in vitro fertilization cycles. Int J Fert Sterril 8(1):29–34

40.

Almog B, Shehata F, Sheizaf B, Tan SL, Tulandi T (2011) Effects of ovarian endometrioma on the number of oocytes retrieved for in vitro fertilization. Fertil Steril 95(2):525–571CrossRefPubMed

41.

42.

Alborzi S, Momtahan M, Parsanezhad ME, Dehbashi S, Zolghadri J, Alborzi S (2004) A prospective, randomised study comparing laparoscopic ovarian cystectomy versus fenestration and coagulation in patients with endometriomas. Fertil Steril 82(6):1633–1637CrossRefPubMed

43.

Takashima A, Takeshita N, Otaka K, Kinoshita T (2013) Effects of bipolar electrocoagulation versus suture after laparoscopic excision of ovarian endometrioma on the ovarian reserve and outcome of in vitro fertilization. J Obstet Gynaecol Res 39(7):1246–1252CrossRefPubMed

44.

Alborzi S, Ravanbakhsh R, Parsanezhad ME, Alborzi M, Alborzi S, Dehbashi S (2007) A comparison of follicular response of ovaries to ovulation induction after laparoscopic ovarian cystectomy or fenestration and coagulation versus normal ovaries in patients with endometrioma. Fertil Steril 88(2):507–509CrossRefPubMed

45.

Beretta P, Franchi M, Ghezzi F, Busacca M, Zupi E, Bolis P (1998) Randomised clinical trial of two laparoscopic treatments of endometriomas: cystectomy versus drainage and coagulation. Fertil Steril 70(6):1176–1180CrossRefPubMed

46.

Park H, Kim CH, Kim EY, Moon JW, Kim SH, Chae HD, Kang BM (2015) Effect of second-line surgery on in vitro fertilization outcome in infertile women with ovarian endometrioma recurrence after primary conservative surgery for moderate to severeendometriosis. Obstet Gynecol Sci 58(6):481–486CrossRefPubMedPubMedCentral

47.

Yu HT, Huang HY, Lee CL, Soong YK, Wang CJ (2015) Side of ovarian endometrioma does not affect the outcome of in vitro fertilization/intracytoplasmic sperm injection in infertile women after laparoscopic cystectomy. J Obstet Gynaecol Res 41(5):717–721CrossRefPubMed

48.

Li Z, Zhang HY, Zhu YJ, Hu YJ, Qu PP (2014) Randomised study comparing the side effects and hormonal status of triptorelin and leuprorelin following conservative laparoscopic surgery for ovarian endometriosis in Chinese women. Eur J Obstet Gynecol Reprod Biol 183:164–168CrossRefPubMed

49.

Roustan A, Perrin J, Debals-Gonthier M, Paulmyer-Lacroix O, Agostini A, Courbiere B (2015) Surgical diminished ovarian reserve after endometrioma cystectomy versus idiopathic DOR: comparison of in vitro fertilization outcome. Hum Reprod 30(4):840–847CrossRefPubMed

50.

Tsoumpou I, Kyrgiou M, Gelbaya TA, Nardo LG (2009) The effect of surgical treatment for endometrioma on in vitro fertilization outcomes: a systematic review and meta-analysis. Fertil Steril 92(1):75–87CrossRefPubMed

51.

Benschop L, Farquhar C, van der Poel N, Heineman MJ (2010) Interventions for women with endometrioma prior to assisted reproductive technology. Cochrane Database Syst Rev. 11:008571

52.

Elter K, Oral E (2014) Surgical treatment before assisted reproductive technologies. Semin Reprod Med 32(4):253–261CrossRefPubMed

53.

Tang Y, Chen SL, Chen X, He YX, Ye DS, Guo W, Zheng HY, Yang XH (2013) Ovarian damage after laparoscopic endometrioma excision might be related to the size of cyst. Fertil Steril 100(2):464–469CrossRefPubMed

54.

Somigliana E, Ragni G, Benedetti F, Borroni R, Vegetti W, Crosignani PG (2003) Does laparoscopic excision of endometriotic ovarian cysts significantly affect ovarian reserve? Insights from IVF cycles. Hum Reprod 18:2450–2453CrossRefPubMed

55.

Somigliana E, Berlanda N, Benaglia L, Vigano P, Vercellini P, Fedele L (2012) Surgical excision of endometriomas and ovarian reserve: a systematic review on serum antimullerian hormone level modifications. Fertil Steril 98(6):1531–1538CrossRefPubMed

56.

Muzii L, di Tucci C, di Feliciantonio M, Marchetti C, Perniola G, Benedetti Panici P (2014) The effect of surgery for endometrioma on ovarian reserve evaluated by antral follicle count: a systematic review and meta-analysis. Hum Reprod 29(10):2190–2198CrossRefPubMed

57.

Harb HM, Gallos ID, Chu J, Harb M, Coomarasamy A (2013) The effect of endometriosis on in vitro fertilisation outcome: a systematic review and meta-analysis. BJOG 120(11):1308–1320CrossRefPubMed

58.

Hong SB, Lee NR, Kim SK, Kim H, Jee BC, Suh CS, Kim SH, Choi YM (2017) In vitro fertilization outcomes in women with surgery induced diminished ovarian reserve after endometrioma operation: comparison with diminished ovarian reserve without ovarian surgery. Obstet Gynecol Sci 60(1):63–68CrossRefPubMedPubMedCentral

59.

Opøien HK, Fedorcsak P, Byholm T, Tanbo T (2011) Complete surgical removal of minimal and mild endometriosis improves outcome of subsequent IVF/ICSI treatment. Reprod BioMed Online 23(3):389–395CrossRefPubMed

60.

Barri PN, Coroleu B, Tur R, Barri-Soldevila PN, Rodríguez I (2010) Endometriosis-associated infertility: surgery and IVF, a comprehensive therapeutic approach. Reprod BioMed Online 21(2):179–185CrossRefPubMed

61.

Hart RJ, Hickey M, Maouris P, Buckett W (2008) Excisional surgery versus ablative surgery for ovarian endometriomata. Cochrane Database Syst Rev (2):CD004992. https://doi.org/10.1002/14651858.CD004992.pub3

62.

Aflatoonian A, Rahmani E, Rahsepar M (2013) Assessing the efficacy of aspiration and ethanol injection in recurrent endometrioma before IVF cycle: a randomised clinical trial. Iran J Reprod Med 11(3):179–184PubMedPubMedCentral

63.

Esinler I, Bozdag G, Aybar F, Bayar U, Yaradi H (2006) Outcome of in vitro fertilization/intracytoplasmic sperm injection after laparoscopic cystectomy for endometriomas. Fertil Steril 85:1730–1735CrossRefPubMed

64.

Kahyaoglu S, Ertas E, Kahyaoglu I, Mollamahmutoglu L, Batioglu S (2008) Does laparoscopic cystectomy and cauterization of endometriomas greater than 3 cm diminish ovarian response to controlled ovarian hyperstimulation during IVF-ET? A case-control study. J Obstet Gynaecol Res 34(6):1010–1013PubMed

65.

Loh FH, Tan AT, Kumar J, Ng SC (1999) Ovarian response after laparoscopic ovarian cystectomy for endometriotic cysts in 132 monitored cycles. Fertil Steril 72:316–321CrossRefPubMed

66.

Loo TC, Lin M, Chen SH, Chung MT, Tang HH, Lin LY et al (2005) Endometrioma undergoing laparoscopic ovarian cystectomy: its influence on the outcome of in vitro fertilization and embryo transfer (IVF-ET). J Assist Reprod Genet 22:329–333CrossRefPubMed

67.

Matalliotakis I, Cakmak H, Mahutte N, Fragouli Y, Arici A, Sakkas D (2007) Women with advanced-stage endometriosis and previous surgery respond less well to gonadotrophin stimulation, but have similar IVF implantation and delivery rates compared with women with tubal factor infertility. Fertil Steril 88:1568–1572CrossRefPubMed

68.

Nargund G, Cheng WC, Parsons J (1995) The impact of ovarian cystectomy on ovarian response to stimulation during in vitro fertilization cycles. Hum Reprod 11:81–83CrossRef

69.

Wu MH, Tsai SJ, Pan HA, Hsiao KY, Chang FM (2003) Three-dimensional power Doppler imaging of ovarian stromal blood flow in women with endometriosis undergoing in vitro fertilization. Ultrasound Obstet Gynecol 21:480–485CrossRefPubMed

Title: The effect of surgical management of endometrioma on the IVF/ICSI outcomes when compared with no treatment? A systematic review and meta-analysis
Authors: M. Nickkho-Amiry
R. Savant
K. Majumder
E. Edi-O’sagie
M. Akhtar
Publication date: 01-04-2018
Publisher: Springer Berlin Heidelberg
Published in: Archives of Gynecology and Obstetrics / Issue 4/2018
Print ISSN: 0932-0067
Electronic ISSN: 1432-0711
DOI: https://doi.org/10.1007/s00404-017-4640-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

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

Abstract

Objective

Design

Setting

Patients

Interventions

Main outcome measures

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objective

Design

Setting

Patients

Interventions

Main outcome measures

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 4/2018

Prognostic roles of neutrophil to lymphocyte ratio and platelet to lymphocyte ratio in ovarian cancer: a meta-analysis of retrospective studies

Evaluation of psychosocial and biological parameters in women seeking for a caesarean section and women who are aiming for vaginal delivery: a cross-sectional study

Trial of labor following one previous cesarean delivery: the effect of gestational age

Genital epidermal horn cyst (atheroma) after female genital mutilation WHO type III b

Effect of swimming exercise on premenstrual syndrome

Early and late pregnancy outcomes in women treated with cold-coagulation versus LLETZ cervical treatment for cervical intraepithelial neoplasia; a retrospective cohort study