title: An Update on Surgical versus Expectant Management of Ovarian Endometriomas in Infertile Women.
abstract: Ovarian endometriomas are a common manifestation of endometriosis that can represent a more severe stage of the disease. There is much debate over the treatment of these cysts in infertile women, particularly before use of assisted reproductive technologies. Evidence exists that supports surgical excision of ovarian endometriomas, as well as evidence that cautions against surgical intervention. Certain factors need to be examined closely before proceeding with surgery or continuing with expectant management. These include the patient's symptoms, age, ovarian reserve, size and laterality of the cyst, prior surgical treatment, and level of suspicion for malignancy. The most recent evidence appears to suggest that certain patient profiles may benefit from proceeding directly to in vitro fertilization (IVF). These include symptomatic infertile patients, especially those that are older, those that have diminished ovarian reserve, those that have bilateral endometriomas, or those that have had prior surgical treatment. Although endometriomas can be detrimental to the ovarian reserve, surgical therapy may further lower a woman's ovarian reserve. Nevertheless, the presence of an endometrioma does not appear to adversely affect IVF outcomes, and surgical excision of endometriomas does not appear to improve IVF outcomes. Regardless of treatment plan, infertile patients with endometriomas must be counseled appropriately before choosing either treatment path.
authors.affiliation: Division of Reproductive Endocrinology and Infertility, Duke University Medical Center, 5704 Fayetteville Road, Durham, NC 27713, USA.
authors.forename: Sanaz
authors.initials: S
authors.lastname: Keyhan
authors.affiliation: Cardiovascular & Metabolic Diseases, Medical Strategy & Science, Quintiles, Inc., 5927 South Miami Boulevard, Morrisville, NC 27560, USA ; Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC 27710, USA.
authors.forename: Claude
authors.initials: C
authors.lastname: Hughes
authors.affiliation: Division of Reproductive Endocrinology and Infertility, Duke University Medical Center, 5704 Fayetteville Road, Durham, NC 27713, USA.
authors.forename: Thomas
authors.initials: T
authors.lastname: Price
authors.affiliation: Division of Reproductive Endocrinology and Infertility, Duke University Medical Center, 5704 Fayetteville Road, Durham, NC 27713, USA.
authors.forename: Suheil
authors.initials: S
authors.lastname: Muasher
mesh_terms: D015984:Causality; D015897:Comorbidity; D004715:Endometriosis / Q000453:epidemiology* / Q000601:surgery; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D015994:Incidence; D007247:Infertility, Female / Q000453:epidemiology* / Q000517:prevention & control; D010048:Ovarian Cysts / Q000453:epidemiology* / Q000601:surgery*; D010052:Ovariectomy / Q000706:statistics & numerical data*; D017699:Pelvic Pain / Q000453:epidemiology / Q000517:prevention & control*; D011183:Postoperative Complications / Q000453:epidemiology; D012307:Risk Factors; D016896:Treatment Outcome