Which is worse? Comparison of ART outcome between women with primary or recurrent endometriomas

Baris Ata, Barış Ata, Sezcan Mumusoglu, Sezcan Mümüşoğlu, Kiper Aslan, Ayse Seyhan, Ayşe Seyhan, Isil Kasapoglu, Işıl Kasapoğlu, Berrin Avci, Berrin Avcı, Bulent Urman, Bülent Urman, Gürkan Bozdağ, Gurkan Bozdag, Gürkan Uncu, Gurkan Uncu
Human Reproduction · 2017 · vol. 32(7) , pp. 1427–1431 · doi:10.1093/humrep/dex099 · PMID:28498960 · W4250204456
article OA: bronze CC0 ⤵ 15 in-corpus citations
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This retrospective cohort study found that women with recurrent endometriomas have similar live birth rates after ART compared to women with primary endometriomas.

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Abstract

STUDY QUESTİON: Are live birth rates (LBR) different after ART cycles between women with primary or recurrent endometrioma? SUMMARY ANSWER: Women with recurrent endometrioma have similar LBR as compared to patients with primary endometrioma. WHAT IS ALREADY KNOWN: Recurrence rate can be as high as 29% after endometrioma excision. Prior studies on management of endometrioma before ART involve primary endometriomas. There is limited information regarding the prognosis of women with recurrent endometriomas. STUDY DESIGN, SIZE, DURATION: A multicenter retrospective cohort study, including 76 women with primary and 82 women with recurrent endometriomas treated at the participating centers over a 6-year period. PARTICIPANTS/MATERIALS, SETTING, METHODS: Women with endometrioma who underwent ART at three academic ART centers. Couples with another indication for ART were excluded. MAIN RESULTS AND THE ROLE OF CHANCE: Female age, median number of prior failed ART cycles, proportion of patients with bilateral endometrioma (28 versus 28.9%), ovarian stimulation protocols, and total gonadotropin consumption were similar between the study groups. Numbers of metaphase two oocytes (5 versus 6), number of embryos transferred, and the proportion of patients undergoing blastocyst transfer were similar across the study groups. Clinical pregnancy rates (36.6 versus 34.2%, absolute difference 2.4%, 95% CI: -12.5 to 17.3%, P = 0.83) and LBR (35.4 versus 30.3%, absolute difference 5.1%, 95% CI: -9.5 to 19.7%, P = 0.51) per started cycle in recurrent and primary endometrioma were similar. Comparable success rates were also confirmed with logistic regression analysis (OR: 1.14, 95% CI: 0.78-0.57, P = 2.3). LIMITATIONS, REASONS FOR CAUTION: The retrospective design has inherent limitations. Some women with severely decreased ovarian reserve after primary endometrioma excision may not have pursued further treatment. WIDER IMPLICATIONS OF THE FINDINGS: The management of endometrioma prior to ART is controversial but a different management strategy is not required for recurrent endometriomas. Since recurrent endometriomas do not have a worse impact on ART outcome than primary endometriomas, and repeat surgery has a higher risk for complications, conservative management without surgery can be justified. STUDY FUNDING/COMPETING INTEREST(S): No funding or competing interests to declare. TRIAL REGISTRATION NUMBER: None.

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Condition tags

endometriosisendometrioma

MeSH descriptors

Endometriosis Infertility, Female Reproductive Techniques, Assisted Academic Medical Centers Adult Birth Rate Cohort Studies Electronic Health Records Endometriosis Endometriosis Endometriosis Female Humans Infertility, Female Infertility, Female Logistic Models Organ Sparing Treatments Organ Sparing Treatments Ovarian Reserve Postoperative Complications

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References (34)

Cited by (15)

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