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Should endometriomas be treated before IVF-ICSI cycles?
Edgardo Somigliana1, Paolo Vercellini, Paola Viganó
1Department of Obstetrics, Gynecology and Neonatology, Ospedale Maggiore Policlinico, Mangiagalli and Regina Elena, Milan, Italy. dadosomigliana@yahoo.it
Human Reproduction Update
|September 13, 2005
Summary
Laparoscopic excision of ovarian endometriomas may improve spontaneous conception but can damage ovarian reserve for IVF-ICSI cycles. Evidence does not support surgery increasing IVF pregnancy rates.
Area of Science:
- Gynecology
- Reproductive Medicine
- Surgical Oncology
Background:
- Ovarian endometriomas are common, and their surgical management before assisted reproductive technology (ART) is debated.
- Laparoscopic excision is frequently performed, but its impact on ovarian reserve and in vitro fertilization (IVF) outcomes requires careful consideration.
Purpose of the Study:
- To evaluate the impact of laparoscopic endometrioma excision on ovarian reserve and IVF-ICSI cycle outcomes.
- To compare the risks and benefits of surgical intervention versus expectant management for women undergoing IVF-ICSI.
Main Methods:
- Review of studies comparing ovarian responsiveness in affected and contralateral ovaries post-excision.
- Analysis of existing evidence regarding pregnancy rates and ovarian reserve after laparoscopic endometrioma excision in women undergoing IVF-ICSI.
Main Results:
- Excision of endometriomas is associated with a quantitative decrease in ovarian reserve.
- Current evidence does not support the notion that laparoscopic surgery improves IVF pregnancy rates.
- Both surgical and expectant management strategies have associated risks and benefits.
Conclusions:
- The value of laparoscopic endometrioma excision prior to IVF-ICSI remains controversial due to potential ovarian reserve damage.
- Expectant management may be favored due to surgical risks and costs, while surgery might be considered for occult malignancy risk or endometriosis progression.
- Alternative treatments like medical therapy and ultrasound-guided aspiration warrant further investigation.