L26/P-359 Surgical Management for Endometrioma Reduces Cumulative Live Birth Rates in Young but Not Advanced Age Women Undergoing IVF: A Propensity Score-Matched Cohort Study

Abstract Study question To evaluate the impact of endometrioma surgery on IVF/ICSI outcomes, especially cumulative live birth rate (CLBR). Summary answer Prior endometrioma surgery is associated with compromised ovarian response and reduced CLBR specifically in women younger than 35 years. What is known already The management of ovarian endometriomas prior to IVF remains a clinical dilemma, involving trade-offs between symptom relief and ovarian reserve loss. And its effect on the CLBR remains controversial. Study design, size, duration A retrospective cohort study from January 2016 to December 2021.A retrospective cohort study from January 2016 to December 2021. Participants/materials, setting, methods Patients were stratified into two groups: 585 with endometrioma surgery prior to IVF/ICSI and 382 without surgery. Propensity score matching (PSM) was utilized to balance baseline characteristics between the two groups (n = 375 pairs). Age-stratified analysis and restricted cubic spline (RCS) modeling were employed to investigate the association between female age and CLBR based on surgery status. Main results and the role of chance After PSM, patients with prior surgery had significantly fewer retrieved oocytes, fewer available embryos, and lower trigger-day estradiol levels compared to the non-surgery group (P < 0.05). No statistically significant differences were observed in the rates of fertilization or blastocyst formation, CCPR and CLBR between the two groups (P > 0.05). However, age-stratified analysis revealed distinct characteristics. In women aged < 35 years, surgical intervention resulted in significantly fewer retrieved oocytes, fewer available embryos, and a lower blastocyst formation rate (P < 0.05). And surgical intervention was associated with a significantly lower CCPR (59.72% vs. 72.08%, P < 0.001) and CLBR (49.18% vs. 59.72%, P = 0.006). In women aged ≥ 35 years, surgery was associated with fewer oocytes and available embryos (P < 0.05), but no statistically significant difference was observed in CCPR (46.20% vs. 48.48%, P = 0.721) or CLBR (37.34% vs. 31.31%, P = 0.325). RCS analysis confirmed that the probability of CLBR was higher in the non-surgery group at younger ages but converged with the surgery group after age 35. Regarding adverse pregnancy outcomes, early miscarriage rate and pregnancy complication rate were comparable across all groups (P > 0.05). Limitations, reasons for caution The diagnoses in the non-surgery group relied on ultrasound rather than histopathology, albeit transvaginal ultrasound has high diagnostic accuracy Wider implications of the findings The findings suggest that the decision to proceed with surgery of endometrioma before IVF requires cautious evaluation and strictly individualized counseling, weighing the risks of diminished ovarian reserve against potential surgical indications. Trial registration number No