National survey of the current management of endometriomas in women undergoing assisted reproductive treatment

F Raffi, Francesca Raffi, Robert W. Shaw, R W Shaw, Saad Amer, S A Amer
Human Reproduction · 2012 · vol. 27(9) , pp. 2712–2719 · doi:10.1093/humrep/des195 · PMID:22695290 · W2163722439
article OA: bronze CC0 ⤵ 18 in-corpus citations
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A UK survey found that most gynecologists offer surgery for ovarian endometriomas before assisted reproductive treatment, often regardless of symptoms or endometrioma size.

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Abstract

STUDY QUESTION: What is the current management of women with ovarian endometriomas undergoing assisted reproductive treatment (ART) in the UK? SUMMARY ANSWER: It appears that the majority of gynaecologists in the UK offer surgery (mostly cystectomy) for endometriomas prior to ART, regardless of the presence of symptoms. WHAT IS KNOWN ALREADY: The ideal management of endometriomas in women undergoing ART remains controversial and presents a dilemma to reproductive specialists. STUDY DESIGN, SIZE AND DURATION: This was a national cross-sectional survey. A total of 388 gynaecologists completed the questionnaire. PARTICIPANTS, SETTINGS AND METHODS: All clinicians fully registered with the Royal College of Obstetricians and Gynaecologists were contacted. An 11-item survey was administered electronically using Survey Monkey software. Quantitative data were analysed using descriptive and comparative statistics. MAIN RESULTS AND THE ROLE OF CHANCE: The majority of responders were consultants (65%), 25% practiced ART and 65% performed laparoscopic surgery. Overall, 95% of responders would offer surgery for endometriomas in women undergoing ART, either on the basis of the size (>3-5 cm) of the endometrioma (52%), the presence of symptoms (16%), the presence of multiple/bilateral endometriomas (2%), regardless of the size and symptoms (19%) or only to women undergoing IVF (6%). The remaining 5% of responders would not offer surgery before ART. Excision was the most common surgical modality (68%), followed by ablation (25%). Laparoscopic surgeons were almost twice as likely to 'offer surgery to all patients with endometriomas prior to ART' compared with clinicians performing laparotomy (22 versus 12%, P < 0.001). LIMITATIONS, REASONS FOR CAUTION: Our overall response rate, with answers to the questionnaire, was low (15%). However, the response rate amongst reproductive specialists was estimated at 60%. It is possible that there might have been an element of bias towards over-representation of responders who are more concerned about 'normalization' of the pelvic anatomy. Furthermore, our survey relied on self-reporting of practice and it is possible that being presented with a list of 'ideal' options may have resulted in respondent bias. WIDER IMPLICATIONS OF THE FINDINGS: Despite the available evidence that surgery for endometriomas does not improve the outcome of ART and may damage ovarian reserve, it seems that the majority of gynaecologists in the UK offer ovarian cystectomy to their patients.

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Condition tags

endometriosisendometrioma

MeSH descriptors

Endometriosis Endometriosis Reproductive Techniques, Assisted Uterine Diseases Uterine Diseases Adult Cross-Sectional Studies Endometriosis Endometriosis Female Gynecology Gynecology Humans Infertility Infertility Infertility Laparoscopy Laparoscopy Practice Patterns, Physicians' Surveys and Questionnaires

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