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 OBJECTIVE: To assess the postoperative likelihood of conception in patients with endometriomas managed by either CO2 laser vaporization or cystectomy. DESIGN: A retrospective study with prospective recording of data. SETTING: University hospital. PATIENTS: One hundred and forty-two patients with symptomatic endometriomas. INTERVENTIONS: Patients 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 RESULTS: The 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. CONCLUSION: CO2 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 Cystectomy Endometriosis Lasers, Gas Ovarian Diseases Pregnancy Rate Pregnancy Rate Adult Adult Carbon Dioxide Carbon Dioxide Endometriosis Endometriosis Female Female Fertilization in Vitro Fertilization in Vitro Fertilization in Vitro Humans Humans

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