Poor pregnancy outcome following assisted reproductive technology among women operated on for bilateral endometriomas

PURPOSE: To determine the first line of infertility treatment for managing patients with unilateral or bilateral ovarian endometriomas. METHODS: We evaluated pregnancy outcome in patients who had received ovarian surgery for unilateral (Group U, n = 47) or bilateral endometriomas (Group B, n = 38) and aspiration with or without alcohol fixation for unilateral (Group u, n = 37) or bilateral endometriomas (Group b, n = 22). Subsequently, 64 of these women, excluding 29 dropouts, underwent assisted reproductive technology. We compared the clinical pregnancy rates of the four groups. RESULTS: The cumulative pregnancy rate after operation of Group B (18%) was significantly lower than that of a cyst-free control group (n = 143; 44%) and Group U (43%). Group B had fewer oocytes fertilized during ART than did Group b (P < 0.005) and fewer blastocysts available for transfer (P < 0.005). The cumulative pregnancy rate of Group B was also lower than in Group b (P = 0.052). CONCLUSIONS: Pregnancy outcomes of Group B were not better than for Group b. Therefore, encouraging such women to move directly to ART might help avoid ovarian damage and improve their ability to achieve a pregnancy.