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

Clara Q. Wu, Wu CQ, Arianne Albert, Alfaraj S, Sukainah Alfaraj, Omur Taskin, Taskin O, Ömür Taşkın, Ghadeer M. Alkusayer, Jon Havelock, Havelock J, Paul Yong, Paul J. Yong, Allaire C, Catherine Allaire, Mohamed A. Bedaiwy
Journal of Minimally Invasive Gynecology · 2018 · vol. 26(2) , pp. 299–311.e3 · doi:10.1016/j.jmig.2018.08.029 · PMID:30717864 · W2898565582
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This systematic review and meta-analysis compares the live birth rates following surgical versus expectant management of endometriomas in women undergoing in vitro fertilization.

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Abstract

Controversy exists regarding surgical management of endometriomas in infertile women before in vitro fertilization (IVF) because growing evidence indicates that surgery may impair the ovarian response. The objective of the present systematic review and meta-analysis was to compare surgical and expectant management of endometriomas regarding IVF outcomes. Prospective and retrospective controlled studies were found via the Cochrane Library, Embase, and MEDLINE databases. Thirteen studies (1 randomized controlled trial and 12 observational studies, N = 2878) were pooled, and similar live birth rates were observed in the surgically and expectantly managed groups (odds ratio = 0.83; 95% confidence interval [CI], 0.56-1.22; p = .98). The clinical pregnancy rates (odds ratio = 0.83; 95% CI, 0.66-1.05; p = .86), the number of mature oocytes retrieved, and the miscarriage rates were not statistically different between study groups. However, the total number of oocytes retrieved was lower in the surgery group (mean difference = -1.51; 95% CI, -2.60 to -0.43; p = .02). Findings suggest that surgical management of endometriomas before IVF therapy yields similar live birth rates as expectant management. However, future properly designed randomized controlled trials are warranted.

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Condition tags

endometriosis

MeSH descriptors

Endometriosis Fertilization in Vitro Infertility, Female Live Birth Ovarian Diseases Watchful Waiting Abortion, Spontaneous Abortion, Spontaneous Birth Rate Cystectomy Cystectomy Endometriosis Endometriosis Epidemiologic Methods Female Humans Infertility, Female Oocyte Retrieval Oocyte Retrieval Ovarian Diseases

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