Effects of ovarian endometrioma aspiration on in vitro fertilization-intracytoplasmic sperm injection and embryo transfer outcomes: a systematic review and meta-analysis

Purpose To evaluate the effect of ovarian endometrioma aspiration on IVF/ICSI outcomes.

The PubMed, EMBASE, Web of Science, China National Knowledge Infrastructure, and Wanfang databases were searched to identify studies related to the treatment of endometrioma up to October 1, 2020, and the data of 1207 patients from 10 studies were analyzed using STATA.

The 10 studies in our analysis included 7 comparing aspiration and surgery and 6 comparing aspiration with no intervention. In the aspiration versus surgery groups, live birth rate [OR 0.97 (95% CI 0.51, 1.85), P = 0.925] and clinical pregnancy rate [OR 1.30 (95% CI 0.95, 1.80), P = 0.105] showed no significant difference between the two groups. Abortion rate [OR 4.26 (95% CI 1.38, 13.08), P = 0.011], the number of oocytes retrieved [mean difference 1.95 (95% CI 0.10, 3.81), P = 0.039], and the estradiol peak on hCG day [mean difference 392.16 (95% CI 230.14, 554.18), P < 0.001] were significantly higher in the aspiration group compared to the surgical group. In the aspiration versus the no intervention group, live birth rate [OR 0.84 (95% CI 0.45, 1.59), P = 0.602] and clinical pregnancy rate [OR 1.25 (95% CI 0.88, 1.77), P = 0.206] were not significantly different between the two groups. The abortion rate [OR 0.31 (95% CI 0.11, 0.88), P = 0.028] and the number of gonadotropin ampoules [mean difference − 3.13 ampoules (95% CI − 4.90, − 1.37), P < 0.001] were significantly lower in the aspiration group compared to the no intervention group.

Compared with surgical treatment or no intervention treatment, aspiration has less effect on ovarian response, ovarian reserve, and pregnancy outcomes. Similar content being viewed by others

Alborzi S, Sorouri ZZ, Askari E, Poordast T, Chamanara K (2019) The success of various endometrioma treatments in infertility: a systematic review and meta-analysis of prospective studies. Reprod Med Biol 18:312–322. https://doi.org/10.1002/rmb2.12286 Kuivasaari P, Hippelainen M, Anttila M, Heinonen S (2005) Effect of endometriosis on IVF/ICSI outcome: stage III/IV endometriosis worsens cumulative pregnancy and live-born rates. Hum Reprod 20:3130–3135. https://doi.org/10.1093/humrep/dei176 Jenkins S, Olive DL, Haney AF (1986) Endometriosis—pathogenetic implications of the anatomic distribution. Obstet Gynecol 67:335–338 Redwine DB (1999) Ovarian endometriosis: a marker for more extensive pelvic and intestinal disease. Fertil Steril 72:310–315. https://doi.org/10.1016/s0015-0282(99)00211-3 Maggiore ULR, Ferrero S (2016) An overview of early drug development for endometriosis. Expert Opin Inv Drug 25:227–247. https://doi.org/10.1517/13543784.2016.1126579 Gupta S, Agarwal A, Agarwal R, Loret R, de Mola J (2006) Impact of ovarian endometrioma on assisted reproduction outcomes. Reprod Biomed Online 13:349–360. https://doi.org/10.1016/s1472-6483(10)61439-3 Pokoradi AJ, Iversen L, Hannaford PC (2011) Factors associated with age of onset and type of menopause in a cohort of UK women. Am J Obstet Gynecol 205:34.e1-34.e13. https://doi.org/10.1016/j.ajog.2011.02.059 Benschop L, Farquhar C, van der Poel N, Heineman MJ (2010) Interventions for women with endometrioma prior to assisted reproductive technology. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD008571.pub2 Ercan CM, Sakinci M, Duru NK et al (2010) Antimullerian hormone levels after laparoscopic endometrioma stripping surgery. Gynecol Endocrinol 26:468–472. https://doi.org/10.3109/09513591003632134 Santulli P, Collinet P, Fritel X et al (2018) Management of assisted reproductive technology (ART) in case of endometriosis related infertility: CNGOF-HAS Endometriosis Guidelines. Gynecol Obstet Fertil Senol 46:373–375. https://doi.org/10.1016/j.gofs.2018.02.025 McDonnell R, Marjoribanks J, Hart RJ (2014) Ovarian cyst aspiration prior to in vitro fertilization treatment for subfertility. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD005999 Liberati A, Altman DG, Tetzlaff J et al (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. J Clin Epidemiol 62:e1-34. https://doi.org/10.1016/j.jclinepi.2009.06.006 Pabuccu R, Onalan G, Goktolga U, Kucuk T, Orhon E, Ceyhan T (2004) Aspiration of ovarian endometriomas before intracytoplasmic sperm injection. Fertil Steril 82(705–711):64 Qublan HS, Amarin Z, Tahat YA, Smadi AZ, Kilani M (2006) Ovarian cyst formation following GnRH agonist administration in IVF cycles: incidence and impact. Human Reprod 21:640–644. https://doi.org/10.1093/humrep/dei371 Zhang X, Lv Q (2016) Effect of different therapy for ovary endomtriotic cysts on the outcome of assisted reproductive. J Pract Obstet Gynecol 04:272–274 Firouzabadi RD, Sekhavat L, Javedani M (2010) The effect of ovarian cyst aspiration on IVF treatment with GnRH. Arch Gynecol Obstet 281:545–549. https://doi.org/10.1007/s00404-009-1195-9 Yazbeck C, Madelenat P, Ayel JP et al (2009) Ethanol sclerotherapy: a treatment option for ovarian endometriomas before ovarian stimulation. Reprod Biomed Online 19:121–125. https://doi.org/10.1016/s1472-6483(10)60055-7 Dong LQ, Ren M, Zhang JH (2018) Effects of different treatments of ovarian cysts on ovarian reserve function and outcomes of in vitro fertilization embryo transfer 9:841–844 Guo Y, Lu N, Zhang Y et al (2012) Comparative study on the pregnancy outcomes of in vitro fertilization-embryo transfer between long-acting gonadotropin-releasing hormone agonist combined with transvaginal ultrasound-guided cyst aspiration and long-acting gonadotropin-releasing hormone agonist alone. Contemp Clin Trials 33:1206–1210. https://doi.org/10.1016/j.cct.2012.07.009 Lee KH, Kim CH, Lee YJ et al (2014) Surgical resection or aspiration with ethanol sclerotherapy of endometrioma before in vitro fertilization in infertile women with endometrioma. Obstet Gynecol Sci 57:297–303. https://doi.org/10.5468/ogs.2014.57.4.297 Li YM, Wang NH, Yue F, Ma XL, Zhang LL, Zhang XH (2017) Effect of different surgical methods for treatment of ovary endometriosis cysts on pregnancy outcome of assisted reproductive technology. J Reprod Med 6:557–561 Suganuma N, Wakahara Y, Ishida D, Asano M, Kitagawa T, Katsumata Y, Moriwaki T, Furuhashi M (2002) Pretreatment for ovarian endometrial cyst before in vitro fertilization. Gynecol Obstet Invest 54(Suppl 1):36–40. https://doi.org/10.1159/000066293 Nickkho-Amiry M, Savant R, Majumder K, Edi-O’sagie E, Akhtar M (2018) The effect of surgical management of endometrioma on the IVF/ICSI outcomes when compared with no treatment? A systematic review and meta-analysis. Arch Gynecol Obstet 297:1043–1057. https://doi.org/10.1007/s00404-017-4640-1 Cohen A, Almog B, Tulandi T (2017) Sclerotherapy in the management of ovarian endometrioma: systematic review and meta-analysis. Fertil Steril 108:117–124. https://doi.org/10.1016/j.fertnstert.2017.05.015 Hamdan M, Dunselman G, Li TC, Cheong Y (2015) The impact of endometrioma on IVF/ICSI outcomes: a systematic review and meta-analysis. Hum Reprod Update 21:809–825. https://doi.org/10.1016/j.fertnstert.2017.05.015 Tsoumpou I, Kyrgiou M, Gelbaya TA, Nardo LG (2009) The effect of surgical treatment for endometrioma on in vitro fertilization outcomes: a systematic review and meta-analysis. Fertil Steril 92:75–87. https://doi.org/10.1016/j.fertnstert.2008.05.049 Demirol A, Guven S, Baykal C, Gurgan T (2006) Effect of endometrioma cystectomy on IVF outcome: a prospective randomized study. Reprod Biomed Online 12:639–643. https://doi.org/10.1016/s1472-6483(10)61192-3 Yanushpolsky EH, Best CL, Jackson KV et al (1998) Effects of endometriomas on oocyte quality, embryo quality, and pregnancy rates in in vitro fertilization cycles: a prospective, case–controlled study. J Assist Reprod Genet 15:193–197. https://doi.org/10.1016/s1472-6483(10)61192-3 Hachisuga T, Kawarabayashi T (2002) Histopathological analysis of laparoscopically treated ovarian endometriotic cysts with special reference to loss of follicles. Human Reprod 17:432–435. https://doi.org/10.1093/humrep/17.2.432 Horikawa T, Nakagawa K, Ohgi S et al (2008) The frequency of ovulation from the affected ovary decreases following laparoscopic cystectomy in infertile women with unilateral endometrioma during a natural cycle. J Assist Reprod Genet 25:239–244. https://doi.org/10.1007/s10815-008-9229-y Benaglia L, Somigliana E, Vercellini P et al (2009) Endometriotic ovarian cysts negatively affect the rate of spontaneous ovulation. Human Reprod 24:2183–2186. https://doi.org/10.1093/humrep/deu308 Barnhart K, Dunsmoor-Su R, Coutifaris C (2002) Effect of endometriosis on in vitro fertilization. Fertil Steril 77:1148–1155. https://doi.org/10.1016/s0015-0282(02)03112-6 Somigliana E, Infantino M, Benedetti F et al (2006) The presence of ovarian endometriomas is associated with a reduced responsiveness to gonadotropins. Fertil Steril 86:192–196. https://doi.org/10.1016/j.fertnstert.2005.12.034 Arici A, Oral E, Bukulmez O et al (1996) The effect of endometriosis on implantation: results from the Yale University in vitro fertilization and embryo transfer program. Fertil Steril 65:603–607. https://doi.org/10.1016/s0015-0282(16)58162-x Cahill DJ, Wardle PG, Maile LA, Harlow CR, Hull MGR (1997) Ovarian dysfunction in endometriosis-associated and unexplained infertility. J Assist Reprod Genet 14:554–557. https://doi.org/10.1023/a:1022568331845 Pal L, Shifren JL, Isaacson KB et al (1998) Impact of varying stages of endometriosis on the outcome of in vitro fertilization-embryo transfer. J Assist Reprod Genet 15:27–31. https://doi.org/10.1023/a:1022574221115 Young VJ, Brown JK, Saunders PTK, Horne AW (2013) The role of the peritoneum in the pathogenesis of endometriosis. Human Reprod Update 19:558–569. https://doi.org/10.1093/humupd/dmt024 Oral E, Arici A, Olive DL, Huszar G (1996) Peritoneal fluid from women with moderate or severe endometriosis inhibits sperm motility: the role of seminal fluid components. Fertil Steril 66:787–792. https://doi.org/10.1016/s0015-0282(16)58637-3 Da Broi MG, Malvezzi H, Paz CCP, Ferriani RA, Navarro PAAS (2014) Follicular fluid from infertile women with mild endometriosis may compromise the meiotic spindles of bovine metaphase II oocytes. Human Reprod 29:315–323. https://doi.org/10.1093/humrep/det378 Sanchez AM, Viganò P, Somigliana E et al (2014) The distinguishing cellular and molecular features of the endometriotic ovarian cyst: from pathophysiology to the potential endometrioma-mediated damage to the ovary. Human Reprod Update 20:217–230. https://doi.org/10.1093/humupd/dmt053 Bulun SE (2014) Ovarian endometriosis: the nemesis of eggs. Fertil Steril 101:938–939. https://doi.org/10.1016/j.fertnstert.2014.01.044 Oliver-Baxter JM, Whitford HS, Turnbull DA, Bond MJ (2018) Effects of vitamin supplementation on inflammatory markers and psychological wellbeing among distressed women: a randomized controlled trial. J Integr Med 16:322–328. https://doi.org/10.1016/j.joim.2018.06.001 Matsuzaki S, Schubert B (2010) Oxidative stress status in normal ovarian cortex surrounding ovarian endometriosis. Fertil Steril 93:2431–2432. https://doi.org/10.1016/j.fertnstert.2009.08.068 Agarwal A, Aponte-Mellado A, Premkumar BJ, Shaman A, Gupta S (2012) The effects of oxidative stress on female reproduction: a review. Reprod Biol Endocrinol 10:49. https://doi.org/10.1186/1477-7827-10-49 Dicker D, Goldman JA, Feldberg D, Ashkenazi J, Levy T (1991) Transvaginal ultrasonic needle-guided aspiration of endometriotic cysts before ovulation induction for invitro fertilization. J In Vitro Fert Embryo Transf 8:286–289. https://doi.org/10.1007/BF01139786 Hsieh CL, Shiau CS, Lo LM, Chang MY (2009) Effectiveness of ultrasound-guided aspiration and sclerotherapy with 95% ethanol for treatment of recurrent ovarian endometriomas. Fertil Steril 91:2709–2713. https://doi.org/10.1016/j.fertnstert.2008.03.056 Wu CQ, Albert A, Alfaraj S et al (2019) Live birth rate after surgical and expectant management of endometriomas after in vitro fertilization: a systematic review, meta-analysis, and critical appraisal of current guidelines and previous meta-analyses. J Minim Invasive Gynecol 26:299–311. https://doi.org/10.1016/j.jmig.2018.08.029 (2020) Chinese expert consensus on ultrasound-guided sclerotherapy for ovarian endometriotic cysts. Chin J Ultrasonogr 29:1013–1024. Mittal S, Kumar S, Kumar A, Verma A (1999) Ultrasound guided aspiration of endometrioma—a new therapeutic modality to improve reproductive outcome. Int J Gynecol Obstet 65:17–23. https://doi.org/10.1016/s0020-7292(98)00218-5 O’Neill MJ, Rafferty EA, Lee SI et al (2001) Transvaginal interventional procedures: aspiration, biopsy, and catheter drainage. Radiographics 21:657–672. https://doi.org/10.1148/radiographics.21.3.g01ma20657 AlKudmani B, Gat I, Buell D et al (2018) In vitro fertilization success rates after surgically treated endometriosis and effect of time interval between surgery and in vitro fertilization. J Minim Invasive Gynecol 25:99–104. https://doi.org/10.1016/j.jmig.2017.08.641 Dicker D, Ashkenazi J, Feldberg D et al (1993) Severe abdominal complications after transvaginal ultrasonographically guided retrieval of oocytes for in vitro fertilization and embryo transfer. Fertil Steril 59:1313–1315. https://doi.org/10.1016/s0015-0282(16)55997-4 Garcia-Velasco JA, Alvarez M, Palumbo A, Gonzalez-Gonzalez A, Ordas J (1998) Rupture of an ovarian endometrioma during the first trimester of pregnancy. Eur J Obstet Gynecol Reprod Biol 76:41–43. https://doi.org/10.1016/s0301-2115(97)00152-8 Fernando S, Breheny S, Jaques AM et al (2009) Preterm birth, ovarian endometriomata, and assisted reproduction technologies. Fertil Steril 91:325–330. https://doi.org/10.1016/j.fertnstert.2008.01.096 Dunselman GAJ, Vermeulen N, Becker C et al (2014) ESHRE guideline: management of women with endometriosis. Human Reprod 29:400–412. https://doi.org/10.1093/humrep/det457 Muzii L, Luciano AA, Zupi E, Panici PB (2014) Effect of surgery for endometrioma on ovarian function: a different point of view. J Minim Invasive Gynecol 21:531–533. https://doi.org/10.1016/j.jmig.2014.03.022 Guo SW (2009) Recurrence of endometriosis and its control. Human Reprod Update 15:441–461. https://doi.org/10.1093/humupd/dmp007 Chapron C, Vercellini P, Barakat H, Vieira M, Dubuisson JB (2002) Management of ovarian endometriomas. Human Reprod Update 8:591–597. https://doi.org/10.1093/humupd/8.6.591 Zhu W, Tan Z, Fu Z et al (2011) Repeat transvaginal ultrasound-guided aspiration of ovarian endometrioma in infertile women with endometriosis. Am J Obstet Gynecol 204:61.e1-61.e6. https://doi.org/10.1016/j.ajog.2010.08.040

The authors thank all the participants of this study. In addition, we would like to thank Editage (www.editage.cn) for English language editing. Funding This study was supported by the National Natural Science Foundation of China (82071617). Author information Authors and Affiliations Contributions XYG: Data collection, data analysis, manuscript writing/editing. YSZ: Data collection, data analysis, manuscript writing/editing. XXX: Data collection, data analysis, manuscript writing/editing. LY: Protocol development, manuscript writing/editing. SML: Protocol development, manuscript writing/editing. All authors reviewed and approved the final manuscript. Corresponding author Ethics declarations Conflict of interest The authors declare that they have no conflict of interest. Availability of data and material The data in this article are obtained from public databases that are open and transparent. Code availability Not applicable. Ethics approval Not applicable. Consent to participate Not applicable. Additional information Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Rights and permissions About this article Cite this article Gao, X., Zhang, Y., Xu, X. et al. Effects of ovarian endometrioma aspiration on in vitro fertilization-intracytoplasmic sperm injection and embryo transfer outcomes: a systematic review and meta-analysis. Arch Gynecol Obstet 306, 17–28 (2022). https://doi.org/10.1007/s00404-021-06278-2 Received: Accepted: Published: Version of record: Issue date: DOI: https://doi.org/10.1007/s00404-021-06278-2