The presence of ovarian endometrioma adversely affect ovarian reserve and response to stimulation but not oocyte quality or IVF/ICSI outcomes: a retrospective cohort study

Cheng Zeng, Ruihui Lu, Xin Li, Yanrong Kuai, Sheng Wang, Qing Xue
Journal of ovarian research · 2022 · vol. 15(1) , pp. 116 · doi:10.1186/s13048-022-01042-9 · PMID:36273148 · W4307066994
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⚙ AI-generated summary by claude@2026-06, 2026-06-08 ⓘ

Ovarian endometriomas were associated with diminished ovarian reserve and stimulation response but did not negatively impact oocyte quality or cumulative live birth rates in IVF/ICSI cycles.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-10 ⓘ

This retrospective cohort study of 2067 women undergoing their first IVF/ICSI cycles (January 2018–December 2020) compared 154 patients with ovarian endometriomas to 1913 controls without endometriosis, using propensity score matching for age, BMI, and infertility duration. Women with ovarian endometriomas had significantly lower ovarian reserve markers (AMH and AFC) and fewer follicles, oocytes, embryos, and top-quality embryos than matched controls, but cumulative live birth rate was comparable between groups (55.64% vs 54.34%). Multivariable analysis identified age and top-quality embryos as associated with cumulative live birth rate, and among unoperated patients there was a negative correlation between endometrioma size and AFC; larger cysts (≥6 cm) were linked to worse ovarian reserve, and contralateral ovaries showed lower AFC in the presence of endometriomas while oocyte counts were similar. This paper is centrally about endometriosis — specifically, it evaluates how ovarian endometriomas affect ovarian reserve, stimulation response, embryo quality, and IVF/ICSI outcomes.

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Abstract

BACKGROUND: The possible impact of ovarian endometriomas (OMAs) on in vitro fertilization (IVF) outcomes remains controversial. Therefore, this study aimed to assess the impact of OMAs on IVF cycle parameters, including ovarian reserve and response to stimulation, embryo quality and pregnancy outcomes. METHODS: This retrospective cohort study included 2067 patients undergoing their first IVF/ICSI cycles between January 2018 and December 2020. The study group included 154 infertile women who had OMAs. The control group consisted of 1913 women without endometriosis, and finally 305 women were matched according to maternal age, body mass index (BMI), and infertility duration by propensity score matching (PSM). Cumulative live birth rate (CLBR) was set as the primary outcome measure. Logistic regression analysis was conducted on the basis of clinical covariates assessed for their association with CLBRs. Subgroup analyses were performed to evaluate the effect of ovarian surgery, cyst size and laterality on CLBRs. RESULTS: Women with OMAs had significantly lower ovarian reserve markers (AMH and AFC), number of follicles, oocytes, embryos, and top-quality embryos than women in the control group (p < 0.05). However, the CLBRs were comparable between the two groups (55.64% versus 54.34%, p = 0.806), regardless of previous history of ovarian surgery. Multivariate analysis revealed association between age (OR = 0.861; 95% CI [0.806-0.921]; p = 0.000), top-quality embryos (OR = 1.829; 95% CI [1.526-2.193]; p = 0.000) and the CLBRs. A negative correlation between OMA size and AFC levels in patients with unoperated OMAs was detected (r = -0.264, p = 0.007). Meanwhile, significant decrease in ovarian reserve with lower AFC, fewer oocytes, embryos and top-quality embryos were observed in patients with OMAs size ≥ 6 cm (p < 0.05). Moreover, ovaries with OMAs had a significantly lower AFC (P = 0.006) but similar number of oocytes when compared with contralateral ovaries without OMAs. CONCLUSION: Infertile women with OMAs were implicated in considerable decreases in ovarian reserve and response to stimulation, but no apparent adverse effects on oocyte quality or clinical outcomes. OMAs surgery and OMAs size may adversely affect ovarian reserve, but not CLBR.

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Condition tags

mesh:D004715endometriosisendometriomainfertility

MeSH descriptors

Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Infertility, Female Infertility, Female Infertility, Female Infertility, Female Infertility, Female Infertility, Female Infertility, Female Ovarian Reserve Ovarian Reserve Ovarian Reserve Ovarian Reserve Ovarian Reserve Ovarian Reserve Ovarian Reserve

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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.

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