Endometrioma, fertility, and assisted reproductive treatments: connecting the dots

Cecchino GN, Gustavo Nardini Cecchino, Gustavo N Cecchino, Juan A. García-Velasco
Current opinion in obstetrics & gynecology · 2018 · vol. 30(4) , pp. 223–228 · doi:10.1097/gco.0000000000000464 · PMID:29847457 · W2806712221
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This review highlights that surgery for ovarian endometrioma does not improve assisted reproductive treatment outcomes and suggests a shift toward conservative management due to potential ovarian damage from surgery.

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Abstract

PURPOSE OF REVIEW: Surgery has traditionally been the primary treatment option for endometriosis-related infertility of any phenotype. However, advances and refinements of assisted reproductive technologies (ART) permit a more conservative approach in many scenarios. This review summarizes the latest findings in the field of reproductive medicine, which have supported a paradigm shift towards more conservative management of ovarian endometrioma. RECENT FINDINGS: The presence of ovarian endometrioma per se is likely to impair ovarian reserve and alter ovarian functional anatomy. Conventional laparoscopic surgery is associated with significant risk of additional damage, and less invasive treatment approaches require further evaluation. With regard to infertile women with ovarian endometrioma who are scheduled for ART treatment, current data indicate that prior surgical intervention does not improve ART outcomes, and that controlled ovarian hyperstimulation (COH) does not affect quality of life or pain symptoms. SUMMARY: Reproductive medicine physicians frequently encounter patients with ovarian endometrioma. The current evidence does not support the postponement of infertility treatment in favour of surgery, except in cases with severe symptoms or to improve follicle accessibility. Although these patients may exhibit diminished ovarian response to COH, their endometrial receptivity, aneuploidy rates, and fertility outcomes are similar to healthy controls. Surgery for ovarian endometrioma provides no benefits in ART treatments.

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Condition tags

endometriosisendometriomainfertility

MeSH descriptors

Endometriosis Infertility, Female Ovarian Diseases Reproductive Techniques, Assisted Endometriosis Endometriosis Female Humans Infertility, Female Infertility, Female Ovarian Diseases Ovarian Diseases Ovarian Reserve Patient Selection

Citation neighborhood

Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. [ expand to 2 hops ] — adds papers reached through this work's immediate citers/citees. Heavier; up to 60 extra dots.

References (88)

Cited by (16)

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License: CC0 · commercial use OK