Fertility Outcome after CO2 Laser Vaporization versus Cystectomy in Women with Ovarian Endometrioma: A Comparative Study

Massimo Candiani, Ferrari S, Stefano Ferrari, Ludovica Bartiromo, Matteo Schimberni, Iacopo Tandoi, Tandoi I, Ottolina J, Jessica Ottolina
Journal of Minimally Invasive Gynecology · 2020 · vol. 28(1) , pp. 34–41 · doi:10.1016/j.jmig.2020.07.014 · PMID:32712323 · W3044647751
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This study compared fertility outcomes in women with ovarian endometriomas treated with CO2 laser vaporization versus cystectomy.

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Abstract

Study objectiveTo assess the postoperative likelihood of conception in patients with endometriomas managed by either CO2 laser vaporization or cystectomy.DesignA retrospective study with prospective recording of data.SettingUniversity hospital.PatientsOne hundred and forty-two patients with symptomatic endometriomas.InterventionsPatients underwent a standardized laparoscopic stripping technique (Group 1) or cyst vaporization with CO2 fiber laser (Group 2). Patients wishing to become pregnant were allowed to attempt a spontaneous conception after surgery. If spontaneous conception failed, patients were referred for in vitro fertilization (IVF).Measurements and main resultsThe primary objective was to compare pregnancy rates between the 2 groups. The secondary objective was the identification of independent predictors of pregnancy. Thirty-nine women in Group 1 (53.4%) and 39 women in Group 2 (56.5%) desired to conceive after surgery. Three patients (7.7%) in Group 1 became pregnant following donor-IVF and were excluded. Pregnancies were recorded in 72.2% of patients treated with cystectomy and in 74.3% of those managed with CO2 fiber laser (p = .83). Twenty patients (55.6%) in Group 1 and 14 patients (35.9%) in Group 2 conceived spontaneously (p = .08). Among patients who failed spontaneous conception, 21 patients (28%) achieved pregnancy through IVF (Group 1: n = 6, 16.7%; Group 2: n = 15, 38.5%; p = .08). Twenty patients (26.7%) never became pregnant. Age at the time of surgery (odds ratio (OR) = 0.86; 95% Confidence intervals (CI): 0.78-0.96, p = .002) and duration of infertility (OR=0.80; 95% CI: 0.69-0.92, p = .006) were identified as independent indicators for pregnancy.ConclusionCO2 laser-treated endometrioma is associated with pregnancy rates equal to those observed after cystectomy and favorable IVF outcomes. The one step CO2 fiber laser technique may represent a viable alternative to cystectomy.

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Condition tags

endometriosisendometrioma

MeSH descriptors

Cystectomy Endometriosis Lasers, Gas Ovarian Diseases Pregnancy Rate Adult Carbon Dioxide Endometriosis Female Fertilization in Vitro Fertilization in Vitro Humans Laparoscopy Lasers, Gas Ovarian Diseases Pregnancy Retrospective Studies

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