Removal of endometriomas before in vitro fertilization does not improve fertility outcomes: a matched, case-control study.
OBJECTIVE
To investigate whether conservative surgery on ovarian endometriomas before an IVF cycle improves fertility outcomes.


METHODS
Retrospective, matched case-control study.


METHODS
Two academic IVF programs.


METHODS
One hundred eighty-nine women with endometriomas who underwent IVF treatment: 56 women proceeded directly to IVF, and 133 first underwent conservative ovarian surgery.


METHODS
Controlled ovarian hyperstimulation and IVF-ET.


METHODS
Response to gonadotropins, fertilization, implantation, and pregnancy rates.


RESULTS
Aside from lower peak E(2) levels on the day of hCG and a higher total FSH dose in women previously operated for an endometrioma, no significant differences were found between the two groups in the different IVF variables analyzed.


CONCLUSIONS
Laparoscopic cystectomy for endometriomas before commencing an IVF cycle does not improve fertility outcomes. Proceeding directly to controlled ovarian hyperstimulation in women with asymptomatic ovarian endometriomas might reduce the time to pregnancy, the costs of treatment, and the hypothetical complications of laparoscopic surgery. Conversely, conservative surgical treatment of ovarian endometriomas in symptomatic women does not impair IVF or intracytoplasmic sperm injection success rates.
Garcia-Velasco
Juan A
JA
Instituto Valenciano de Infertilidad, Madrid, Spain. jgvelasco@ivi.es
Mahutte
Neal G
NG
Corona
José
J
Zúñiga
Victor
V
Gilés
Juan
J
Arici
Aydin
A
Pellicer
Antonio
A
D000328:Adult; D016022:Case-Control Studies; D015653:Cystectomy; D004715:Endometriosis / Q000601:surgery*; D005260:Female; D005298:Fertility; D005307:Fertilization in Vitro; D006801:Humans; D010535:Laparoscopy; D010049:Ovarian Diseases / Q000601:surgery*; D012189:Retrospective Studies