{"paper_id":"c1c89d2a-3e7c-4aa0-868d-1cfacdc8e996","body_text":"www.ogscience.org 297\nReceived: 2013.11.29.   Revised: 2014.1.2.  Accepted: 2014.1.14.\nCorresponding author: Chung-Hoon Kim\nDivision of Reproductive Endocrinology and Infertility, \nDepartment of Obstetrics and Gynecology, University of Ulsan \nCollege of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, \nSongpa-gu, Seoul 138-736, Korea\nTel: +82-2-3010-3639  Fax: +82-2-3010-6944\nE-mail: chnkim@amc.seoul.kr\nArticles published in Obstet Gynecol Sci are open-access, distributed under the terms of \nthe Creative Commons Attribution Non-Commercial License (http://creativecommons.\norg/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, \nand reproduction in any medium, provided the original work is properly cited.\nCopyright © 2014 Korean Society of Obstetrics and Gynecology \nIntroduction\nEndometriosis is one of the most common indications for as-\nsisted reproductive technologies (ARTs) because endometrio-\nsis can cause subfertility with anatomical damage and various \ninflammatory substances. Although the association between \nminimal or mild endometriosis and infertility is less clear, there \nis little debate that moderate or severe endometriosis can im-\npair fertility.\nThere has been some evidence that the presence of ovar -\nian endometrioma impairs the quality of oocyte as revealed \nSurgical resection or aspiration with ethanol \nsclerotherapy of endometrioma before in vitro \nfertilization in infertilie women with endometrioma\nKyung-Hee Lee, Chung-Hoon Kim, You-Jeong Lee, Sung-Hoon Kim, Hee-Dong Chae, Byung-Moon Kang\nDivision of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan \nMedical Center, Seoul, Korea\nObjective\nTo evaluate whether the surgical resection or aspiration with ethanol sclerotherapy (AEST) of endometrioma before \nin vitro  fertilization (IVF) affect controlled ovarian stimulation (COS) and IVF outcome in the infertilie women with \nendometroma undergoing IVF . \nMethods \nIn this retrospective cohort study, 101 consecutive IVF/intracytoplasmic sperm injection cycles that were performed in \n101 patients with endometrioma(s) between January 2008 and December 2012 were included. Before IVF , 36 patients \nunderwent surgical resection of endometrioma (resection group), 29 patients had transvaginal endometrioma AEST \n(aspiration group), and 36 patients did not take any surgical intervention (control group). The three groups were \ncompared in terms of COS and IVF outcomes.\nResults\nTotal antral follicle count was significantly lower in the resection group than in the aspiration or control group. The \nnumbers of follicles with a diameter of 14 to 17 mm on the human chorionic gonadotropin day, retrieved oocytes, \nmature oocytes, and fertilized oocytes were significantly lower in the resection group than in two other groups. \nHowever, three groups were similar in terms of clinical pregnancy rate (CPR) per initiated cycle, CPR per embryo \ntransfer, embryo implantation rate, and miscarriage rate. \nConclusion \nNeither of surgical resection and AEST of endometrioma before IVF treatment can give any beneficial effect on IVF \noutcomes. Moreover, surgical resection of endometrioma can affect the ovarian reserve and ovarian response during \nCOS.\nKeywords: Aspiration with ethanol sclerotherapy; Endometriosis; Fertilization in vitro; Surgical resection\nOriginal Article\nObstet Gynecol Sci 2014;57(4):297-303\nhttp://dx.doi.org/10.5468/ogs.2014.57.4.297\npISSN 2287-8572 · eISSN 2287-8580\n\nwww.ogscience.org298\nVol. 57, No. 4, 2014\nby their fertilization and implantation ability [1-3]. However, \nthe influences of ovarian endometrioma on the outcome of \nART is still controversial and the optimal treatment of ovarian \nendometrioma before in vitro fertilization (IVF) treatment now \nopen for debate. Recently, interventions for women with en-\ndometrioma prior to ART was investigated in Cochrane review \nanalyzing 4 randomized controlled trials. They analyzed the \nefficacy of aspiration or cystectomy versus expectant manage-\nment to find no evidence of a benefit for clinical pregnancy \nwith either technique. However, they could not evaluate the \nlive birth rate in their study and indicated that there is too \nmuch clinical and statistical heterogeneity between the tri -\nals to compare their results [4]. Moreover, there is limited \ndata that compare the efficacy of the aspiration and surgical \nremoval of endometrioma before ART in one study. Therefore, \nwe performed the study to investigate the effect of surgical \nresection and transvaginal aspiration with ethanol sclerother-\napy (AEST) of endometrioma before IVF on controlled ovarian \nstimulation (COS) and IVF outcome in the infertilie women \nwith endometroma undergoing IVF .\nMaterials and methods\n1. Patients\nThis retrospective cohort study included 101 consecutive IVF/\nintracytoplasmic sperm injection (ICSI) cycles that were per -\nformed in 101 patients with endometrioma(s) between Janu-\nary 2008 and December 2012. Of 101 patients, 36 patients un-\nderwent surgical resection of endometrioma (resection group), \n29 patients had transvaginal endometrioma AEST (aspiration \ngroup) before IVF/ICSI, and 36 patients did not take any surgi-\ncal intervention (control group). This study was approved by the \nInstitutional Review Board of Asan Medical Center, University of \nUlsan College of Medicine (IRB number: 2013-1090). The clini-\ncal information was obtained by chart review.\nThe following selection criteria were adopted for this study: \n1) women with pathologically confirmed endometrioma(s) \npreviously (resection group, aspiration group) or with \nendometrioma(s) of a mean diameter of >3 cm or diagnosed \nby transvaginal ultrasonography (control group); 2) women of \n20 to 45 years old at the time of screening; 3) women with \nnormal ovulatory cycles of 24 to 35 days in length; and 4) \nbody mass index (BMI) between 18 and 25 kg/m\n2\n.\nPatients with current endocrine abnormalities such as dia -\nbetes mellitus, polycystic ovary syndrome, hyperprolactinemia \nwere excluded from this study. Patients who had any ab -\nnormalities that would interfere with adequate stimulation, \nprevious hospitalization due to severe ovarian hyperstimula-\ntion syndrome, or a history of previous (within 12 months) or \ncurrent abuse of alcohol or drugs were also excluded from the \npresent study.\nIn the resection group, the patients who underwent IVF \nwithin 5 years from the surgical resection of endometrioma \nwere included regardless of the type of COS protocol. We in-\ncluded the patients who had the resection of endometrioma \nonly once and excluded the patients in whom fulguration of \npelvic endometriosis or adhesiolysis without the resection of \nendometrioma was performed. All patients included in the \nresection group were pathologically confirmed as endome -\ntriosis. In the aspiration group, the patients who underwent \nIVF within 1 year from AEST of endometrioma were recruited \nregardless of the type of COS protocol. In the control group, \nthe patients who had IVF without any intervention for endo-\nmetrioma before IVF treatment were included. We excluded \nthe patient with recurrent endometrioma having previous sur-\ngical resection of ovarian endometrioma from the aspiration \nor control group. \nIf patients underwent two or more cycles of IVF/ICSI during \nthe study period, charts corresponding to the first IVF/ICSI \ncycle were reviewed and data of other IVF/ICSI cycles except \nfirst cycle were excluded from this analysis.\n2.  Transvaginal aspiration with ethanol sclerotherapy \nof endometrioma\nTransvaginal AEST of endometrioma was performed as an \noutpatient procedure under intravenous sedation using pro -\npofol sodium. Patients were placed in the lithotomy position, \nand monitored using an electrocardiogram and a pulse ox -\nimeter. Under transvaginal ultrasound guidance, 35 cm long \n18-gauge needle was inserted through the vaginal fornix into \nthe endometrioma. The endometriotic cyst content was aspi-\nrated and flushed twice or three times with 20% pure sterile \nethanol (Merck Serono SA, Geneva, Switzerland) in a volume \nequal to 80% to 90% of the aspirated volume. The aspirated \nendometriotic fluid was sent for cytologic analysis. \n3.  Controlled ovarian stimulation and in vitro \nfertilization treatment \nGonadotropin releasing hormone (GnRH) agonist long pro -\n\nwww.ogscience.org 299\nKyung-Hee Lee, et al. Intervention of endometrioma before IVF\ntocol or GnRH antagonist protocol was used for COS in all \nsubjects. In the GnRH agonist long protocol, daily injection \nof a GnRH agonist 1 mg (Leuprorelin acetate, Lorelin, Dong-\nkook, Seoul, Korea) was initiated during the midluteal phase \nof the preceding menstrual cycle and was continued at least \nfor 14 days, followed by a dose reduction to 0.5 mg daily. \nGnRH agonist 0.5 mg was continued daily up to day of hu -\nman chorionic gonadotropin (hCG) administration. Ovarian \nstimulation was started with 150 to 300 IU of recombinant \nhuman follicle-stimulating hormone (rhFSH; Gonal-F , Merck \nSerono SA) after establishing ovarian and uterine quiescence \nusing vaginal ultrasound. The rhFSH dose was adjusted every \n3 to 4 days according to the ovarian response. A recombinant \nhCG (rhCG; Ovidrel, Merck Serono SA) of 250 μg was injected \nto induce follicular maturation when one or more follicles \nreached a mean diameter of ≥18 mm. Oocyte retrieval (OR) \nwas performed 35 to 36 hours after hCG injection, and 1 to 4 \nembryos were transferred into the uterus on the third day af-\nter OR. Vaginal progesterone gel (Crinone 8% 90 mg, Merck \nSerono SA) once daily was administrated from the day of OR \nfor luteal support.\nIn the GnRH antagonist protocol, ovarian stimulation was \ncommenced with 150 to 300 IU of rhFSH, from the third day \nof menstruation after establishing ovarian and uterine quies-\ncence by using transvaginal ultrasound. The rhFSH dose was \nadjusted every 3 to 4 days according to the ovarian response. \nWhen the leading follicle reached 13 to 14 mm in an average \ndiameter, GnRH antagonist cetrorelix (Cetrotide, Merck Serono \nSA) at a dose of 0.25 mg/day was started and continued daily \nup to the day of hCG injection. When one or more follicles \nreached a mean diameter of 18 mm or more, a single subcu-\ntaneous bolus of 250 µg rhCG (Ovidrel, Merck Serono SA) was \nadministered simultaneously with GnRH agonist 0.1 mg (Deca-\npeptyl, Ferring, Malmö, Sweden). OR and luteal support were \nperformed in same manner with GnRH agonist long protocol.\nAfter IVF or ICSI, one to four embryos were transferred \ninto the uterus on the third day after OR. Starting on the day \nof OR, all patients received 90 mg of vaginal progesterone \ngel (Crinone gel 8%, Merck Serono SA) once daily for luteal \nphase support. The β-hCG serum levels were measured 11 \ndays after embryo transfer (ET). The β-hCG serum levels were \nmeasured by radioimmunoassay using a hCG MAIA clone kit \n(Serono Diagnostics, Woking, UK) with interassay and intra-\nassay variances of <10% and 5%, respectively,11 days after \nET . Clinical pregnancy was defined as the presence of a gesta-\ntional sac by ultrasonography, while miscarriage rate per clini-\ncal pregnancy was defined as the proportion of patients who \nfailed to continue development before 20 weeks of gestation \nin all clinical pregnancies. \n4. Statistical analysis\nMean values were expressed as mean±standard deviation. \nTable 1. Patients’ characteristics\nCharacteristic Cystectomy group \n(n=36) AEST  group (n=29) Control group \n(n=36) P-value\nAge of patients (yr) 33.6±2.9 34.6±4.9 34.3±4.3 NS\nAge of husbands (yr) 35.6±3.2 36.7±4.5 35.5±4.4 NS\nInfertility duration (mo)  41.0±35.3   45.6±29.1   34.9±28.8 NS\nBMI (kg/m\n2\n) 21.9±2.1 21.6±1.7 21.6±1.7 NS\nNo. of nullipara     31 (86.1)     25 (86.2)     31 (86.1) NS\nAFC     8.2±3.9\na)\n11.1±3.8 11.2±4.7 0.007\nNo. of patients with AFC ≤6    18 (50)\nb)\n    10 (34.4)       5 (13.9) 0.005\nD uration between intervention and IVF (mo)   20.3±19.5   3.1±3.0 − <0.001\nS ize of endometrioma before resection or AEST (mm)   58.8±15.3   51.5±18.2 - NS\nS ize of endometrioma on the day of OR (mm)   22.6±24.1   15.5±21.9 36.4±8.2 NS\nValues are presented as mean±standard deviation or number (%). \nAEST, aspiration and ethanol sclerotherapy; NS, not significant; BMI, body mass index; AFC, antral follicle count; OR, oocyte retrieval; IVF , in \nvitro fertilization.\na)\nSignificantly lower than in the aspiration or control group ( P=0.024, P=0.017, respectively); \nb)\nSignificantly higher than in the aspiration \nor control group (P=0.005, P=0.005).\n\nwww.ogscience.org300\nVol. 57, No. 4, 2014\nAnalysis of variance test with Bonferroni’s post hoc correction \nwas used to compare mean values among three groups while \nchi-square test and Fisher exact test were used to compare \nfractions. Statistical significance was defined as P<0.05. All \nanalyses were performed by using SPSS ver. 11.0 (SPSS Inc., \nChicago, IL, USA). \nResults\nThe three groups did not differ in terms of the ages of the \npatients and their spouses, BMI, infertility duration, and the \nproportion of nullipara. The duration between surgery and OR \nwas 20.3±19.5 months and the size of recurred endometrio-\nma on the day of OR was 22.6±24.1 mm in resection group. \nThe duration between AEST and OR was 3.1±3.0 months and \nthe size of endometrioma on the day of OR was 15.5±21.9 \nmm in AEST group. The size of endometrioma on the day of \nOR in control group was 36.4±8.2 mm. Total antral follicle \ncount (AFC) was significantly lower in the resection group \nthan in the aspiration or control group (P=0.007). The propor-\ntion of patients with AFC ≤6 was significantly higher in the \nresection group than in other two groups (P=0.005) (Table 1).\nIn the resection group, 1 out of 36 cycles initiated (2.7%) \nwas cancelled before ET because no available oocytes were \nretrieved. Two out of 29 cycles initiated (6.8%) in the aspi -\nTable 2. Comparison of controlled ovarian stimulation results and in vitro fertilization/intracytoplasmic sperm injection outcome\nCystectomy group \n(n=36)\nAEST  group \n(n=29)\nControl group \n(n=36) P-value\nNo. of cycles initiated 36 29 36 −\nNo. of cycles retrieved 36 29 36 −\nNo. of ET cycles 35 27 34 −\nNo. of cycles cancelled 1 (2.7)   2 (6.8)   2 (5.5) NS\nNo. of GnRH antagonist protocol 13 (36.1)   11 (37.9)   13 (36.1) NS\nDays of rhFSH  11.9±3.2 12.1±2.8 12.0±2.8 NS\nTotal dose of rhFSH (IU) 1,940.2±407.1 2,015.5±673.5 1,818.7±490.1 NS\nNo. of follicles on hCG day\n14 to <17 mm  4.1±2.1\na)\n6.1±3.2   6.2±3.5 0.003\n≥17 mm 3.3±3.0 3.1±1.4   3.8±2.0 NS\nEMT on hCG day 10.2±1.2 10.3±1.4 10.0±1.2 NS\nNo. of oocytes retrieved  8.2±4.7\nb)\n12.4±7.6 12.4±7.5 0.016\nNo. of mature oocytes  6.9±3.7\nc)\n10.5±6.4 10.7±6.7 0.010\nNo. of fertilized oocytes  5.4±3.3\nd)\n8.4±5.3  8.1±4.8 0.012\nNo. of grade I, II embryos 1.8±1.0 1.7±0.8  1.7±1.1 NS\nNo. of embryos transferred 2.7±1.0 3.2±1.1  2.9±0.9 NS\nCPR per cycle initiated (%)  36.1 (13/36)  41.3 (12/29)   38.8 (14/36) NS\nCPR per ET (%)  37.1 (13/35)  44.4 (12/27)   41.1 (14/34) NS\nMiscarriage rate (%)  7.6 (1/13)  8.3 (1/12) 14.2 (2/14) NS\nLBR per cycle initiated (%)  33.3 (12/36)  40.7 (11/27)   33.3 (12/36) NS\nMultiple PR per clinical pregnancy (%)  7.6 (1/13)  8.3 (1/12)   7.1 (1/14) NS\nValues are presented as mean±standard deviation or number (%) unless otherwise indicated. \nAEST, aspiration and ethanol sclerotherapy; ET, embryo transfer; NS, not significant; GnRH, gonadotropin releasing hormone; rhFSH, recom-\nbinant human follicle stimulating hormone; hCG, human chorionic gonadotropin; EMT, endometrial thickness; CPR, clinical pregnancy rate; \nLBR, live birth rate; PR, pregnancy rate.\na)\nSignificantly lower than in the aspiration or control group ( P=0.017, P=0.008, respectively); \nb)\nSignificantly lower than in the aspiration \nor control group (P=0.05, P=0.031, respectively); \nc)\nSignificantly lower than in the aspiration or control group ( P=0.042, P=0.018, respec-\ntively); \nd)\nSignificantly lower than in the aspiration or control group (P=0.028, P=0.037, respectively).\n\nwww.ogscience.org 301\nKyung-Hee Lee, et al. Intervention of endometrioma before IVF\nration group and 2 out of 36 cycles initiated (5.5%) in the \ncontrol group were also cancelled before ET because available \noocytes were not retrieved. There was no significant difference \nin overall cycle cancellation rate among three groups.\nThe numbers of 14 to 17 mm follicles, retrieved oocytes, \nmature oocytes, fertilized oocytes were significantly lower in \nthe resection group than in other two groups. However, three \ngroups were similar in terms of the number of follicles more \nthan 17 mm on hCG day, total dose and days of gonadotro-\npin used for COS, the numbers of grade I or II embryos and \ntransferred embryos, clinical pregnancy rate (CPR) per initiated \ncycle, CPR per ET , embryo implantation rate, miscarriage rate, \nand multiple pregnancy rate (Table 2).\n \nDiscussion\nEndometriosis is a multifactorial disease that seriously com -\npromises the female fertility. The mechanisms by which endo-\nmetriosis impairs fertility have not been completely proven, \nbut there are some reliable hypotheses. Severe endometriosis \nis associated with pelvic adhesions and a distortion of pelvic \nanatomy leading to a possible anatomic disturbance of fertil-\nity. In addition, endometriosis may have a direct negative \neffect on follicular development, oocyte development, em -\nbryogenesis, or implantation even in a mild stage. Mediating \nfactors are supposed to be local paracrine action of interleu-\nkins or other cytokines, alteration in inflammatory response or \nautoimmune factors [1,3].\nMany treatment have been proposed and applied to \novercome the infertility associated with endometriosis. In a \nmeta-analysis of 22 independent studies, Barnhart et al. [2] \ndetermined that the overall likelihood of achieving pregnancy \nrate was significantly lower for stage III–IV endometriosis pa-\ntients compared with tubal factor control subjects. However, \nin spite of a lower success rate compared with that of women \nundergoing IVF for other indications, IVF is still the most suc-\ncessful form of ART that can be offered to an infertile couple \nwith endometriosis. It has already been demonstrated that \nthe presence of endometriosis decreases pregnancy rates for \ncouples who attempt conception without ARTs or with ovula-\ntion induction [5-7].\n Whether surgical resection improves the IVF outcome is stiil \nup for debate. Whereas some studies concluded that ovarian \ncystectomy may be deleterious to residual oocyte and hor -\nmone function [5,8,9], another study showed no differences \nin fertility outcomes among patients who underwent the re -\nsection of endometrioma, patients with endometriosis without \novarian endometriomas, and patients with tubal infertility [10]. \nIn addition, there are some evidences that ovarian cystectomy \nfor endometriomas should be associated with significantly \ndiminished ovarian reserve after surgery [11,12]. A meta-\nanalysis by Somigliana et al. [13] concluded that serum anti-\nmüllerian hormone (AMH) level declines after the stripping of \novarian endometrioma and the magnitude of this reduction is \nmore evident in women operated for bilateral cysts. Although \nthe pathogenetic mechanisms mediating the injury to the \novarian reserve remain to be elucidated, the stripping proce-\ndure may determine the accidental removal of healthy ovarian \ntissue [14]. This was analyzed by Kitajima et al. [15] who indi-\ncated the presence of normal ovarian tissue in the enucleated \ncyst as a significant factor influencing the rate of serum AMH \ndecline. A recent meta-analysis of five studies concluded that \nsurgical management of endometriomas has no significant ef-\nfect on IVF outcome and ovarian response to COS compared \nwith no treatment [16].\nAnother option for managing endometrioma is AEST of the \nendometriotic cyst under transvaginal ultrasound guidance. \nThere are still conflicting data whether this intervention is \nbeneficial for fertility outcome. Guo et al. [17] performed the \nretrospective comparative study on the pregnancy outcomes \nof IVF-ET between long-acting GnRH agonist combined with \ntransvaginal ultrasound-guided cyst aspiration and long-\nacting GnRH agonist alone in 134 infertile women. They \nconcluded that serum E2 level on hCG day, the numbers of \novarian follicles of ≥14 mm in diameter and oocytes retrieved, \nhigh-quality embryo rate, implantation rate, and CPR were \nsignificantly higher in cyst aspisration group than in control \ngroup [16]. In a study on the efficacy of aspiration of ovarian \nendometriomas before ICSI, study subjects were divided into \nfour groups (aspiration of endometriomas at the beginning \nof COS in patients with ovarian endometriomas with no his -\ntory of previous surgery, nonaspirated endometriomas with \nno history of previous surgery, history of ovarian surgery for \nendometriomas in patients without ovarian endometriomas \nat the beginning of COS, and tubal factor infertility) [18]. They \ndemonstrated that neither cyst aspiration with or without \nalcohol fixation nor surgical resection of endometrioma pres-\nent any beneficial effect of reproductive outcome [18]. One \nprospective study comparing IVF outcomes with or without \n\nwww.ogscience.org302\nVol. 57, No. 4, 2014\npretreatment in patients with endometrioma demonstrated \nthat neither cyst aspiration nor surgical resection of endome-\ntrioma is necessary for ovarian endometrial cyst before IVF-ET . \nHowever, they proposed that cyst aspiration may be beneficial \nafter several failed attempts of IVF for slightly increased fertil-\nization rate although it was statistically not significant [19].\nIn the present study, we investigated the impact of surgi -\ncal resection and AEST of endometrioma before IVF/ICSI in \ninfertile patients. Our study did not show any beneficial effect \nof surgical resection and AEST of endometrioma on improving \nreproductive outcome in IVF cycles. Moreover, surgical resec-\ntion of endometrioma can affect the ovarian reserve and ovar-\nian response during COS.\nHowever, AEST of endometriomas before IVF may be consid-\nerable in patients with large endometrioma(s) interfering with \nOR because AEST can reduce the volume of endometriomas \nwithout decrease of ovarian reserve.\nIn conclusion, pretreatment including surgical resection \nand AEST of endometrioma cannot give any beneficial effect \nbefore IVF/ICSI. Considering that surgical resection of endo -\nmetrioma could affect ovarian reserve and ovarian response \nduring COS, resection of endometrioma should be avoided in \nthe patient with low ovarian reserve including elderly women. \nHowever, our study has a limitation to evaluate the effect of \nsurgical resection and AEST of endometriomas before IVF due \nto a small number of sample available and the characteristics \nof objects were heterogenous due to its retrospective nature. \nMoreover, there were some limitation to obtain the surgical \ninformation because all the patient included in the resection \ngroup did not have operation in our hospital. Therefore, well-\ndesigned prospective randomized trials are required to con -\nfirm the results of our present study in infertile patients with \novarian endometriomas.\nConflict of interest\nNo potential conflict of interest relevant to this article was \nreported.\nReferences\n  1. Ayers JW, Birenbaum DL, Menon KM. Luteal phase dys -\nfunction in endometriosis: elevated progesterone levels \nin peripheral and ovarian veins during the follicular \nphase. Fertil Steril 1987;47:925-9.\n  2. Barnhart K, Dunsmoor-Su R, Coutifaris C. Effect of \nendometriosis on in vitro fertilization. Fertil Steril \n2002;77:1148-55.\n  3. Hahn DW, Carraher RP , Foldesy RG, McGuire JL. Experi-\nmental evidence for failure to implant as a mechanism \nof infertility associated with endometriosis. Am J Obstet \nGynecol 1986;155:1109-13.\n  4. Benschop L, Farquhar C, van der Poel N, Heineman MJ. \nInterventions for women with endometrioma prior to as-\nsisted reproductive technology. Cochrane Database Syst \nRev 2010;(11):CD008571.\n  5. Falcone T, Goldberg JM, Miller KF . Endometriosis: medi-\ncal and surgical intervention. Curr Opin Obstet Gynecol \n1996;8:178-83.\n  6. Kodama H, Fukuda J, Karube H, Matsui T, Shimizu Y, \nTanaka T. Benefit of in vitro fertilization treatment \nfor endometriosis-associated infertility. Fertil Steril \n1996;66:974-9.\n  7. Pagidas K, Falcone T, Hemmings R, Miron P . Comparison \nof reoperation for moderate (stage III) and severe (stage \nIV) endometriosis-related infertility with in vitro fertiliza -\ntion-embryo transfer. Fertil Steril 1996;65:791-5.\n  8. Benaglia L, Somigliana E, Vighi V , Ragni G, Vercellini P , \nFedele L. Rate of severe ovarian damage following sur -\ngery for endometriomas. Hum Reprod 2010;25:678-82.\n  9. Loh FH, Tan AT, Kumar J, Ng SC. Ovarian response after \nlaparoscopic ovarian cystectomy for endometriotic cysts \nin 132 monitored cycles. Fertil Steril 1999;72:316-21.\n10. Canis M, Pouly JL, Tamburro S, Mage G, Wattiez A, Bru-\nhat MA. Ovarian response during IVF-embryo transfer \ncycles after laparoscopic ovarian cystectomy for en -\ndometriotic cysts of >3 cm in diameter. Hum Reprod \n2001;16:2583-6.\n11. Biacchiardi CP, Piane LD, Camanni M, Deltetto F, Del -\npiano EM, Marchino GL, et al. Laparoscopic stripping \nof endometriomas negatively affects ovarian follicular \nreserve even if performed by experienced surgeons. Re -\nprod Biomed Online 2011;23:740-6.\n12. Hirokawa W, Iwase A, Goto M, Takikawa S, Nagatomo \nY, Nakahara T, et al. The post-operative decline in \nserum anti-Mullerian hormone correlates with the bi -\nlaterality and severity of endometriosis. Hum Reprod \n2011;26:904-10.\n\nwww.ogscience.org 303\nKyung-Hee Lee, et al. Intervention of endometrioma before IVF\n13. Somigliana E, Berlanda N, Benaglia L, Vigano P , Vercellini \nP, Fedele L. Surgical excision of endometriomas and \novarian reserve: a systematic review on serum antimy \nand severity of endometriosis. Fertil Steril 2012;98:1531-\n8.\n14. Garcia-Velasco JA, Somigliana E. Management of endo -\nmetriomas in women requiring IVF: to touch or not to \ntouch. Hum Reprod 2009;24:496-501.\n15. Kitajima M, Khan KN, Hiraki K, Inoue T , Fujishita A, Masu-\nzaki H. Changes in serum anti-Müllerian hormone levels \nmay predict damage to residual normal ovarian tissue \nafter laparoscopic surgery for women with ovarian endo-\nmetrioma. Fertil Steril 2011;95:2589-91.e1.\n16. Tsoumpou I, Kyrgiou M, Gelbaya TA, Nardo LG. The ef -\nfect of surgical treatment for endometrioma on in vitro \nfertilization outcomes: a systematic review and meta-\nanalysis. Fertil Steril 2009;92:75-87.\n17. Guo YH, Lu N, Zhang Y , Su YC, Wang Y , Zhang YL, et al. \nComparative study on the pregnancy outcomes of in \nvitro fertilization-embryo transfer between long-acting \ngonadotropin-releasing hormone agonist combined with \ntransvaginal ultrasound-guided cyst aspiration and long-\nacting gonadotropin-releasing hormone agonist alone. \nContemp Clin Trials 2012;33:1206-10.\n18. Pabuccu R, Onalan G, Goktolga U, Kucuk T, Orhon \nE, Ceyhan T. Aspiration of ovarian endometriomas \nbefore intracytoplasmic sperm injection. Fertil Steril \n2004;82:705-11.\n19. Suganuma N, Wakahara Y , Ishida D, Asano M, Kitagawa T , \nKatsumata Y , et al. Pretreatment for ovarian endometrial \ncyst before in vitro fertilization. Gynecol Obstet Invest \n2002;54 Suppl 1:36-40.","source_license":"CC0","license_restricted":false}