Should endometriomas be treated before IVF-ICSI cycles?
The laparoscopic excision of ovarian endometriomas appears to increase the chances of spontaneous conception, but the value of this treatment in women selected for IVF-ICSI cycles is debated. Studies recruiting women with unilateral disease and comparing ovarian responsiveness in the affected and contralateral intact gonads indicate that excision of endometriomas is associated with a quantitative damage to ovarian reserve. There are no randomized trials comparing laparoscopic excision to expectant management before IVF-ICSI cycles. The idea that surgery increases IVF pregnancy rates is not supported by the available evidence. However, the chance of conception is not the only issue that has to be considered. Some potential drawbacks are associated with both therapeutical strategies. Specifically, costs and hazard of surgical complications support expectant management whereas oocyte retrieval risks, the possibility of missing occult malignancy and endometriosis progression due to ovarian stimulation would favour surgical treatment. Alternative therapeutical options include medical treatment and ultrasound-guided aspiration. Whereas prolonged GnRH agonist down-regulation may be beneficial, data on ultrasound aspiration are more controversial.
Somigliana
Edgardo
E
Department of Obstetrics, Gynecology and Neonatology, Ospedale Maggiore Policlinico, Mangiagalli and Regina Elena, Milan, Italy. dadosomigliana@yahoo.it
Vercellini
Paolo
P
Viganó
Paola
P
Ragni
Guido
G
Crosignani
Pier Giorgio
PG
D002986:Clinical Trials as Topic; D004715:Endometriosis / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D005260:Female; D005298:Fertility; D005307:Fertilization in Vitro; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects; D006801:Humans; D010535:Laparoscopy; D008297:Male; D010053:Ovary / Q000502:physiology*; D011247:Pregnancy; D012307:Risk Factors; D020554:Sperm Injections, Intracytoplasmic