Comparison of Laparoscopic versus Conventional Treatment of Ovarian Endometrioma

An observational prospective cohort study was conducted with a historical control group and 140 infertile women with the laparoscopic diagnosis of ovarian endometrioma over 1 cm diameter. The groups were comparable regarding age, duration of infertility, and disease severity. All patients had a follow-up of 12 months after treatment, and at least one patent tube. The laparoscopic group (group A) consisted of 46 woman, 35 of whom received suppressive treatment with danazol, Gestinone, or leuprolide acetate for 4 to 6 months. In the control group (group B), 94 women underwent diagnostic laparoscopy plus 6 months of danazol or Gestinone therapy. After 3 months, microsurgery by laparotomy was performed. During the follow-up, period 24 pregnancies were achieved in group A (52%) and 58 in group B (61%, chi2 0.796). Fifteen (48%) of 31 women with cysts 1 to 3 cm in group A conceived, as did 52 (62%) of 81 in group B. Nine (60%) of the 15 with cysts over 3 cm in group A, and 7 (58%) of 12 in group B conceived. No significant difference was found among the suppressive drugs in either group. Only 4 (36%) of the 11 women in group A not receiving suppressive treatment became pregnant. No significant difference (p >0.05) was found when comparing the combined treatment group (57%). According to the revised classification of endometriosis, 18 (51%) of 35 pregnancies were achieved in women with moderate disease in group A and 41 (64%) of 64 in group B. In those with severe disease, 6 (55%) of 11 became pregnant in group A and 17 (57%) of 30 in group B. There was no significant difference between the groups when comparing global results, ovarian endometrioma size, medical treatment, and severity of endometriosis. Given comparable surgical expertise, operative laparoscopy should be the procedure of choice in the treatment of ovarian endometrioma whenever possible, due to its recognized advantages.