Could surgical management improve the IVF outcomes in infertile women with endometrioma?: a review

Hyun Jong Park, Hannah Kim, Geun Ho Lee, Tae Ki Yoon, Woo Sik Lee
Obstetrics & gynecology science · 2019 · vol. 62(1) , pp. 1 · doi:10.5468/ogs.2019.62.1.1 · PMID:30671388 · W2909712829
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⚙ AI-generated summary by claude@2026-06, 2026-06-08 ⓘ

This review assesses the efficiency and application of surgical intervention and IVF for infertile women with advanced endometriosis or endometrioma, finding limited benefits for surgery prior to IVF.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-08 ⓘ

This review examines how advanced-stage endometriosis and endometrioma affect IVF outcomes and whether surgical management before IVF improves reproductive results, synthesizing evidence from clinical research, reviews, and meta-analyses searched up to December 31, 2017. It reports that IVF outcomes generally worsen with increasing endometriosis stage and that endometrioma can directly impair oocyte quality and ovarian function, while surgery—particularly laparoscopic excision—commonly reduces ovarian reserve as reflected by decreased AMH, with the paper noting selection bias and limited observational evidence as key caveats in some pooled analyses. It concludes that there is no evidence supporting surgery before IVF to improve subsequent IVF outcomes in infertile women with advanced-stage endometriosis or endometrioma, while also outlining specific scenarios described in the literature where surgery may be considered for access or urgency. This paper is centrally about endometriosis — it reviews endometrioma and advanced-stage endometriosis in relation to IVF outcomes and the impact of pre-IVF surgery.

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Abstract

Endometriosis is a chronic inflammatory condition that affects fertility and could be toxic to the ovary. Endometrioma per se and surgical interventions for endometrioma significantly reduce the ovarian reserve. Therefore, to prepare for surgical intervention for endometrioma, the high-risk group with decreased ovarian reserve must be considered. There is no evidence to support the use of surgical intervention before in vitro fertilization (IVF) to improve the reproductive outcomes of subsequent IVF in infertile women with advanced-stage endometriosis or endometrioma. As surgical treatment has few benefits, IVF could be recommended immediately for aiding conception in these women. However, the reproductive prognosis of IVF may be worse in the more advanced stages of endometriosis. When dysmenorrhea is severe or when cancer is suspected, surgery prior to IVF may be necessary and justified. When the size of the endometrioma is very large, surgery could be required prior to IVF to facilitate access to follicles during oocyte retrieval or to improve the ovarian response to controlled ovarian stimulation. Prolonged pituitary downregulation in women with surgically diagnosed endometriosis may be helpful to increase the clinical pregnancy rate in subsequent IVF cycles. The purpose of this paper was to review the efficiency and clinical application of the surgical intervention and IVF for infertile women with advanced-stage endometriosis or endometrioma.

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Condition tags

endometriosisendometriomadysmenorrhea

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