Pretreatment for Ovarian Endometrial Cyst before in vitro Fertilization

Abstract

Assisted reproductive technology is a widely accepted treatment for infertile women with endometriosis. The presence of an ovarian endometrial cyst reduces the quality of oocytes, while surgical resection of endometrioma may reduce the ovarian reserve for ovarian stimulation by exogenous gonadotropins. To determine what pretreatment should be performed for ovarian endometrial cyst before IVF-ET, we analyzed IVF outcomes with or without pretreatment in patients with endometrioma. Infertile women with endometrioma who underwent IVF-ET were divided into 3 groups, including patients who had received laparotomy or laparoscopy, patients for whom the endometrioma content had been aspirated and treated with or without alcohol fixation, and patients who did not undergo pretreatment. The number of retrieved oocytes, rate of mature oocytes, and fertilization rate were compared among groups. The results showed that pretreatment for endometrioma reduces the number of retrieved oocytes. Although oocyte quality as a rate of mature oocytes was not affected by the presence of an ovarian endometrial cyst, the fertilization rate was improved by cyst aspiration. We propose that surgical pretreatment is not necessary for ovarian endometrial cyst before IVF-ET, but cyst aspiration may be beneficial after several failed attempts of IVF.

The frequency of ovulation from the affected ovary decreases following laparoscopic cystectomy in infertile women with unilateral endometrioma during a natural cycle

“…Recent evidence suggests that laparoscopic cystectomy of an ovarian endometrioma reduces ovarian reserve and consequently the response to ovarian stimulation [12,[15][16][17][18]. Most of these reports compared the adverse effects of cystectomy on subsequent response to IVF treatments, such as the response to controlled ovarian hyperstimulation and the mean number of oocytes retrieved in operated versus non-operated patients [21,[27][28][29], but there were few A large endometrioma (≥4 cm in diameter) Fig.…”

“…Cystectomy is commonly performed on endometriomas more than 3 cm in diameter before ART treatment [12]. Some studies reported that endometrioma cystectomy had no detrimental effect on controlled ovarian hyperstimula-tion or on ART outcomes [13,14], while some other studies reported that endometrioma cystectomy reduced response to controlled ovarian hyperstimulation [15][16][17][18]. The authors report that reduced ovarian response and decreased ovarian reserve after cystectomy was directly affected by the surgery [15][16][17].…”

Ovarian Endometrioma and Infertility

“…Its effect on IVF is controversial as both Dicker et al [36] and Suganuma et al [37] reported betterand worse outcomes respectively. However it's not without risk as surgical intervention, pelvic abscess, and a recurrence rates 83.3% has been reported [35,[38][39][40] .…”

The Impact of Endometrioma and Its Surgical Treatment on Ovarian Reserve and Reproductive Performance

“…However, the accuracy of this method may be compromised by several factors e.g., the operator's skill, variation in stimulation protocols and the threshold follicle size for ovum retrieval [ 80 ].…”