Long-term reproductive performance after surgery for ovarian endometrioma.
OBJECTIVE
To determine the long-term impact of different types of endometrioma surgery on reproductive performance and on age of menopause.


METHODS
This was a longitudinal observational cohort study of 68 women with previous endometrioma surgery and 68 age- and weight-matched healthy controls. All participants' hospital records were reviewed and each woman completed a questionnaire and attended an interview. Pregnancy rates were compared between the study and control groups. In the study group, pregnancy rates were compared before and after surgery.


RESULTS
Amongst the 38 women desiring pregnancy after endometrioma surgery, 19 (50%) achieved a spontaneous pregnancy during the follow-up period. This was not significantly different from a pre-operative pregnancy rate of 48% (22/46). Of these 19 patients, four achieved another pregnancy with fertility treatment. An additional eight patients conceived only with the help of fertility treatment, giving an overall long-term post-operative pregnancy rate of 71% (27/38). These results were significantly lower (p=0.0001) than the 98% (57/58) long-term natural pregnancy rate in the control group. Pregnancy rates in patients receiving fertility treatment significantly (p=0.001) increased from 7% (1/15) before surgery to 63% (12/19) post-operatively. In post-menopausal women, the median (quartile) age at menopause was similar in the study (n=9) and control groups (n=6) [48 (45-52) versus 49 (44-52) years, respectively].


CONCLUSIONS
Endometriomas per se appear to be the main cause of the reduced long-term reproductive performance of the affected patients, with little or no contribution from surgery. Furthermore, endometrioma surgery seems to improve the success rates of fertility treatment.
Department of Obstetrics and Gynaecology, The University of Nottingham, School of Graduate Entry Medicine and Health, Royal Derby Hospital, Uttoxeter Road, Derby DE22 3DT, United Kingdom. Electronic address: mzxfr1@nottingham.ac.uk.
Francesca
F
Raffi
Department of Obstetrics and Gynaecology, The University of Nottingham, School of Graduate Entry Medicine and Health, Royal Derby Hospital, Uttoxeter Road, Derby DE22 3DT, United Kingdom.
Saad A
SA
Amer
D055011:Ablation Techniques / Q000379:methods; D000328:Adult; D016022:Case-Control Studies; D015331:Cohort Studies; D004322:Drainage / Q000379:methods; D004715:Endometriosis / Q000601:surgery*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008593:Menopause / Q000502:physiology*; D008875:Middle Aged; D010049:Ovarian Diseases / Q000601:surgery*; D010052:Ovariectomy / Q000379:methods; D011247:Pregnancy; D018873:Pregnancy Rate; D027724:Reproductive Techniques, Assisted / Q000706:statistics & numerical data
Fertility; Menopause age; Ovarian endometrioma surgery; Reproductive performance