Second surgery for recurrent endometriomas is more harmful to healthy ovarian tissue and ovarian reserve than first surgery

Muzii, Ludovico; Achilli, Chiara; Lecce, Francesca; Bianchi, Antonella; Franceschetti, Silvia; Marchetti, Cláudia; Perniola, Giorgia; Panici, Pierluigi Benedetti

doi:10.1016/j.fertnstert.2014.12.101

Cited by 99 publications

(61 citation statements)

References 35 publications

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“…One study[43] showed that the recurrence rate of endometriosis after conservative surgery could reach up to 16.9%. Muzii et al[44] found that excisional surgery for recurrent endometriomas appears to be more harmful to the ovarian reserve, as evaluated by AFC.…”

Section: Discussionmentioning

confidence: 99%

Weigh the pros and cons to ovarian reserve before stripping ovarian endometriomas prior to IVF/ICSI: A meta-analysis

Tao

Chen

et al. 2017

PLoS ONE

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PurposeTo explore the effects of conservative surgery for endometriomas on ovarian responsiveness during assisted reproductive technology (ART) and provide reproductive and gynecological doctors with a more reliable reference program for the treatment of endometriomas.MethodsA literature search was performed by searching the PubMed, Embase, Cochrane Library, Web of Science and Science Direct databases. Studies with inter- and intra-patient comparisons of ovarian responses and oocyte quality between operated and unoperated ovaries and that met the inclusion criteria were retrieved, and the data from the outcome measures were extracted and pooled for this meta-analysis.ResultsTwenty-one published studies (2649 ART cycles) were included. The total amount of gonadotropin (Gn) used (inverse variance (IV):0.48; 95% confidence interval (CI): [0.13, 1.82], P = 0.0007) was significantly increased in the women with endometriomas who had a history of cystectomy. The estrogen (E) level on the day of hCG administration (IV: -0.29; 95% CI: [-0.41, -0.17], P<0.00001), the number of mature or dominant follicles (IV: -1.17; 95% CI: [-1.51, -0.82], P<0.00001) and the total number of oocytes retrieved (IV: -1.78; 95% CI: [-2.38, -1.17], P<0.00001) were significantly decreased in the women with endometriomas who had a history of cystectomy. The duration of stimulation (IV: 0.02; 95% CI: [-0.09, 0.13], P = 0.77), the total number of formed embryos (IV: -0.06; 95% CI: [-0.17, 0.04], P = 0.25), the pregnancy rate(IV:0.98;95%CI[0.82,1.18], P = 0.83) and the live birth rate(IV:0.93;95%CI[0.70,1.23], P = 0.61)were not statistically different between the two groups. Similar intra-patient results were found in the number of mature or dominant follicles (IV: -0.88; 95% CI: [-1.25, -0.52], P<0.00001) and the total number of oocytes retrieved (IV: -3.48; 95% CI: [-4.77, -2.19], P<0.00001).ConclusionART might be a better therapeutic method for ovarian endometrioma-related infertility than cystectomy.

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Section: Discussionmentioning

confidence: 99%

Weigh the pros and cons to ovarian reserve before stripping ovarian endometriomas prior to IVF/ICSI: A meta-analysis

Tao

Chen

et al. 2017

PLoS ONE

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“…In contrast, standard treatment for recurrent endometrioma is not yet established and recurrence of endometrioma often necessitates repeat surgery, which decreases the ovarian reserve and increases the risk of ovarian failure . Repeat surgery also results in a greater loss of ovarian tissue than in the initial surgery . Additionally, surgery for recurrent endometriosis becomes more challenging because of the development of postsurgical adhesion in addition to adhesion due to chronic inflammation associated with endometriosis.…”

Section: Introductionmentioning

confidence: 99%

Dienogest therapy during the early stages of recurrence of endometrioma might be an alternative therapeutic option to avoid repeat surgeries

Koshiba

Mori

Okimura

et al. 2018

J of Obstet and Gynaecol

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“…Although some studies suggested that this damage to ovarian reserve is caused by surgery (3)(4)(5), other investigations suggested that it is directly caused by the presence of the endometrioma (25-28); however, little attention has been given to the impact of recurrent endometriomas and their treatment on ovarian reserve (22). The present study investigated for the first time the impact on ovarian reserve of second surgery for recurrent unilateral endometrioma, suggesting that second surgery may have a detrimental effect on ovarian reserve.…”

Section: Discussionmentioning

confidence: 99%

“…Surprisingly little attention has been given to the function of ovaries with recurrent endometriomas (21) and to the impact on ovarian reserve of second surgery for endometriomas (22). The aim of the present study was to investigate the changes in ovarian reserve after laparoscopic excision of recurrent unilateral endometriomas.…”

mentioning

confidence: 95%

Second surgery for recurrent unilateral endometriomas and impact on ovarian reserve: a case-control study

Ferrero

Scala

Racca

et al. 2015

Fertility and Sterility

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Second surgery for recurrent endometriomas is more harmful to healthy ovarian tissue and ovarian reserve than first surgery

Cited by 99 publications

References 35 publications

Weigh the pros and cons to ovarian reserve before stripping ovarian endometriomas prior to IVF/ICSI: A meta-analysis

Weigh the pros and cons to ovarian reserve before stripping ovarian endometriomas prior to IVF/ICSI: A meta-analysis

Dienogest therapy during the early stages of recurrence of endometrioma might be an alternative therapeutic option to avoid repeat surgeries

Second surgery for recurrent unilateral endometriomas and impact on ovarian reserve: a case-control study

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