A Cochrane review «Interventions for women with endometrioma prior to assisted reproductive technology»1 «Benschop L, Farquhar C, van der Poel N et al. Interventions for women with endometrioma prior to assisted reproductive technology. Cochrane Database Syst Rev 2010;(11):CD008571. »1 included 4 studies with a total of 312 subjects. In two trials, surgery (aspiration or cystectomy) versus expectant management (EM) showed no evidence of a benefit for clinical pregnancy with either technique. Aspiration was associated with greater number of mature oocytes retrieved (NMOR) (MD 0.50, 95% CI 0.02 to 0.98) and increased ovarian response (E2 levels on day of hCG injection) (MD 685.3, 95% CI 464.50 to 906.10) compared to EM. Cystectomy was associated with a decreased ovarian response to controlled ovarian hyperstimulation (MD -510.00, 95% CI -676.62 to -343.38); no evidence of an effect on the NMOR compared to EM. Aspiration versus cystectomy showed no evidence of a difference in CPR or the NMOR in one trial. One trial compared gonadotropin-releasing hormone (GnRH) agonist with GnRH antagonist. There was no evidence of a difference for clinical pregnancy rate, however the number of mature oocytes retrieved was greater with GnRH agonists.
A meta-analysis «Park HJ, Kim H, Lee GH et al. Could surgical management improve the IVF outcomes in infertile women with endometrioma?: a review. Obstet Gynecol Sci 2019;62(1):1-10. »3 assessed surgical intervention of endometrioma and the infertility issue. One meta-analysis of observational studies compared endometrioma (no surgery) vs. without endometriosis and found no significant difference in clinical pregnancy rate (CPR) in IVF outcomes (OR, 1.26; 95% CI 0.78 to 2.05, n=237). Another meta-analysis of observational studies showed similar CPR (OR, 1.17; 95% CI 0.87 to 1.58; n=1512) in surgically treated vs. intact endometrioma, and similar CPR (OR, 0.97; 95% CI 0.78 to 1.20; n=893) in surgically treated endometrioma vs. peritoneal endometriosis alone (all IVF outcomes). A third meta-analysis of observational studies comparing endometrioma cystectomy group vs. control group with unoperated ovaries found no significant difference in the pregnancy rate (OR, 0.98; 95% CI 0.82 to 1.18; n=2330) in IVF outcomes.
A meta-analysis «Nickkho-Amiry M, Savant R, Majumder K et al. The effect of surgical management of endometrioma on the IVF/ICSI outcomes when compared with no treatment? A systematic review and meta-analysis. Arch Gyn»2 compared surgery versus no treatment of endometrioma on the outcome of assisted reproduction treatment (ART). 11 studies were included (mostly retrospective case-control studies, only one RCT). 10 studies compared surgical treatment for endometrioma with untreated endometrioma and 4 studies compared surgical treatment of endometrioma with aspiration of endometrioma. Live birth rate/cycle favoured surgical treatment, but the result was insignificant (OR 0.75, 95 CI to 0.54 to 1.06, 4 trials, n=647). There were no significant differences in pregnancy rate per cycle (OR 0.88, 95% CI 0.60 to 1.29, 5 trials) and clinical pregnancy rate (OR 1.08, 95% CI 0.80 to 1.45, 7 trials) between women who underwent surgery for endometrioma and those who did not.