Outcomes of ovarian endometrioma aspiration before ultra-long agonist protocol during ICSI cycles: a multicenter randomized clinical trial

Ovarian endometriomas negatively affect the outcomes of intracytoplasmic sperm injection (ICSI). Numerous procedures and medications have been used to reduce the negative impact of endometriomas on ICSI outcomes. Endometrioma aspiration is one such procedure with controversial results. Objective. To evaluate the therapeutic efficacy and reproductive outcomes of endometrioma aspiration before starting a long ICSI protocol with agonists. Patients and methods. This multicenter randomized clinical trial enrolled 84 women with small ovarian endometrioma (3–5 cm) previously diagnosed by ultrasound in five fertility centers in Egypt from July 2017 to June 2022. Participants were randomly allocated into two groups (n = 42/each). Group I underwent endometrioma aspiration prior to the ultra-long agonist protocol, and group II had only the ultra-long agonist protocol. The rate of clinical pregnancy, cycle cancellation, ovarian hyperstimulation syndrome, endometrioma recurrence, and pelvic infections were measured. Results. Endometrioma size decreased significantly after aspiration. The total dose of gonadotropins and the duration of stimulation were statistically significantly lower in group I compared to the control group (p < 0.001 for both groups). The total number of retrieved and mature oocytes as well as the number of developed embryos were statistically significantly higher in group I than in the control group (p < 0.001 for both groups). However, there were no statistically significant differences between the groups regarding embryo quality and the rates of pregnancy, miscarriage, and live births. Conclusion. Aspiration of small ovarian endometriomas before the ultra-long protocol in ICSI cycles reduced gonadotropin doses, shortened the stimulation period, and increased the number of retrieved oocytes. Nevertheless, there were no significant differences regarding embryo quality and pregnancy rates between the two groups. Key words: endometriosis, ICSI, ovulation, pregnancy