Role of surgical therapy in treating dysmenorrhea and infertility of ovarian endometrioma

Objective To explore clinical characteristics of ovarian endometrioma in particular and the effectiveness of surgical and medical therapy in treating it.Methods The medical records of 850 patients with pathologically proven ovarian endometrioma at Fudan University Hospital from 2003 to 2004 were retrospectively reviewed.Results Among 712 patients who had a follow-up,316 patients(44.38%)mainly complained of dysmenorrhea,42 patients(5.90%)of infertility,294 patients(41.29%)of pelvic mass and 60 patients(8.43%)of dysmenorrhea combined with infertility.Totally 290 out of 712 patients complained of irregular menses(40.73%).The painful symptom was relieved in 87.23% patients who complained of dysmenorrhea.R-AFS score was related to the symptom relief while the surgical mode(conservative and semi-radical surgery)and postoperative GnRHa treatment were not related to it.For all 102 infertile patients,conservative surgery was carried out.The overall post-operative pregnancy rate was 37.25%;the patients who were previously secondary infertile had a higher pregnancy rate than those who were previously primary infertile(53.33% vs 30.56%,P0.05).The r-AFS score and post-operative GnRHa treatment were not in relation to pregnancy rate.Conclusion 1.For patients with ovarian endometrioma,painful symptoms can be relieved after surgery,and r-AFS score is related to symptom relief whereas surgical mode is not.2.Conservative surgery can improve infertility.Patients who are previously secondary infertile have a higher pregnancy rate than those who are primary infertile.However,post-operative GnRHa treatment can't improve infertility.