Aspiration of ovarian endometriomas before intracytoplasmic sperm injection.
OBJECTIVE
To investigate whether aspiration of ovarian endometriomas before controlled ovarian stimulation (COH) improves intracytoplasmic sperm injection (ICSI) outcomes.


METHODS
Prospective study.


METHODS
University hospital.


METHODS
A prospective analysis of 171 patients with ovarian endometriosis and tubal factor infertility were divided into four groups: aspiration of endometriomas at the beginning of COH in patients with ovarian endometriomas and no history of previous surgery (n = 41) (group 1); nonaspirated endometriomas (n = 40) (group 2); history of ovarian surgery for endometriomas in patients without ovarian endometriomas at the beginning of COH (n = 44) (group 3); and tubal factor infertility (n = 46) (control group 4).


METHODS
Aspiration of endometriomas.


METHODS
Clinical parameters, characteristics of COH, and ICSI results were analyzed.


RESULTS
We observed higher levels of E(2) on the day of hCG injection after aspiration of endometriomas compared with nonaspirated endometriomas. When we compared all endometriomas and tubal factor (control) groups, we observed a lower number of total follicles (>17 mm) and metaphase II (MII) oocytes in nonaspirated and resected endometrioma groups and a longer duration of COH in the nonaspirated endometrioma group compared with the tubal factor group. Implantation and clinical pregnancy rates were similar among all groups.


CONCLUSIONS
In the current study, all patients with endometriomas had significantly lower numbers of MII oocytes compared with those in patients with tubal factor infertility. We propose that aspiration of endometriomas before COH neither reduces the amount of gonadotropins nor increases the number of follicles >17 mm, the number of MII oocytes retrieved, the implantation rates, or the clinical pregnancy rates. Resection of small endometriomas (1-6 cm) may not present any additional benefits to the IVF-ICSI cycle outcomes.
Pabuccu
Recai
R
Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Gulhane School of Medicine, 06018 Etlik, Ankara, Turkey. gogsenonalan@yahoo.com
Onalan
Gogsen
G
Goktolga
Umit
U
Kucuk
Tansu
T
Orhon
Esat
E
Ceyhan
Temel
T
D016889:Endometrial Neoplasms / Q000601:surgery*; D004715:Endometriosis / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D010062:Ovulation Induction / Q000379:methods; D012189:Retrospective Studies; D020554:Sperm Injections, Intracytoplasmic; D016896:Treatment Outcome; D014619:Vacuum Curettage