Management of Infertile Women with Endometriosis. What's the Result of Leaving Ovarian Endometrioma during IVF-ET Cycles?

Purpose The awareness of possible risk of damage to ovarian reserves after surgical treatment of ovarian endometriomas supports a more conservative approach in infertile women with ovarian endometrioma. A growing number of patients with ovarian endometrioma undergo In Vitro Fertilization and Embryo Transfer (IVF-ET) prior to surgery. The aim of this study was to assess the effect of ovarian endometrioma on IVF-ET cycles. Methods In a retrospective cohort pilot study, IVF-ET cycles performed by our group during the period 2000–2004 were assessed. One hundred and forty-four women with a history of surgery for endometriosis or endometriosis at the time of the cycle were included in the ‘study group'. Seventy infertile patients because of tubal factor constituted the ‘control group'. IVF-ET outcome was assessed. Results Patients with endometriosis required a higher total dosage of FSH/hMG and attained lower peak E2 levels, and fewer follicles and oocytes were obtained. Clinical pregnancy rate per patient was lower in the endometriosis group (24/144, 16.7%) when compared with tubal factor (20/70, 28.6%), clinical pregnancy rate per embryo transfer was similar (24/117, 20.5% and 20/61, 32.8% respectively). When stratifying results in the endometriosis group, patients with a history of prior surgery for ovarian endometrioma required a higher dosage of FSH/ hMG and attained a lower peak of estradiol. A trend with a consistent reduction in pregnancy rate in women with a history of prior surgery for ovarian endometrioma (5/37, 13% in patients with previous cystectomy and no recurrence; 2/17, 11.8% in patients with prior surgery and recurrence of endometrioma at pick-up; 2/10, 20% in women never operated with endometrioma at pick-up; 15/53, 28.3% in the minimal-mild endometriosis group; 20/61, 32.8% for tubal factor) was observed. Conclusions Both surgery for ovarian endometrioma and the existence of endometrioma during pickup appear to affect IVF-ET outcome. Patients with prior surgery and endometrioma recurrence at the time of pick-up revealed a further decrease in pregnancy rate.