What is the impact of endometrioma on IVF/ICSI outcomes in patients with endometriosis: A retrospective study

What is the impact of endometrioma on IVF/ICSI outcomes in patients with endometriosis: A retrospective study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article What is the impact of endometrioma on IVF/ICSI outcomes in patients with endometriosis: A retrospective study Jui-Chun Chang, Yu-Chiao Yi, Ya-Fang Chen, Hwa-Fen Guu, Hsiao-Fan Kung, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-1755432/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Does endometrioma per se, different from endometriosis, have specific impacts on IVF/ICSI outcomes? Dose cystectomy of the endometrioma improve IVF/ICSI outcomes? Methods We retrospectively analyzed 2153 IVF/ICSI cases treated during Jan/01/2014 to Dec/31/2020 in VGHTC. Two-hundred-and-eight women receiving IVF/ICSI treatment due to endometriosis. The control group consisted of 624 infertile women without endometriosis. First, we divided 208 patients into those with endometrioma (89) and those only with endometriosis (119). Second, we divided patients into primary endometrioma, recurrent endometrioma and those having received cystectomy for endometrioma before IVF/ICSI. Reproductive outcomes were compared. Results We found in the endometrioma subgroup (B), the usage gonadotropin dose was significantly higher, and the blastocyst formation rate was significantly lower compared with endometriosis (A) and control group (C). The CLBR (60.5% versus 49.4% versus 56.9%, p = 0.194 in A versus B, p = 0.406 in A versus C, p = 0.878 in B versus C) were comparable. From the second analysis, the blastocyst formation rate was significantly higher in the s/p cystectomy group. The CLBR were comparable (47.1%, 60% and 57.9% p = 0.194 in D versus E, p = 0.406 in D versus F, p = 0.878 in E versus F, in primary endometrioma (D), s/p cystectomy (E) and recurrent endometrioma group (F)). Conclusions Although the blastocyst formation rate was lower, and the usage gonadotropin dose was higher in the endometrioma group, CLBR was not worse than those with endometriosis or control. Cystectomy for endometrioma did not alter IVF/ICSI outcomes if ovarian reserve is comparable. Recurrent endometrioma did not worsen ART outcome than primary endometrioma. Endometriosis endometrioma IVF/ICSI outcome cystectomy cumulative live birth rates Figures Figure 1 Figure 2 Figure 3 Introduction Endometriosis is a chronic disease and is known to be detrimental to fertility [ 1 ]. Around 25–50% of women with infertility may be affected by endometriosis, and 30–50% of women with endometriosis have infertility [ 2 ]. A significant number of women with endometriosis eventually seek IVF with or without ICSI for conception. An endometrioma is the formation of a cyst within the ovary with ectopic endometrial tissue lining [ 3 ]. It is found in 17–44% of patients with endometriosis [ 4 ]. The exact mechanism by whichendometrioma causes infertility remains uncertain. Several proposed mechanisms include distorting tubo-ovarian anatomy [ 5 ], reduction in the quality and quantity of developing follicles by anatomical proximity of the ovarian cyst to the nearby follicular pool [ 6 , 7 ], and reduced ovarian reserve and embryo quality by local inflammation milieu, toxic content and oxidative damage [ 8 , 9 ]. Although with a higher cancel rate and lower oocyte retrieval, current evidence is that women with endometrioma have similar IVF/ICSI outcome in terms of live birth rate compared with those without endometriosis [ 10 ]. However, there were few studies comparing IVF/ICSI outcomes between women with endometrioma and women with endometriosis. Current molecular, histological and morphological evidence suggested that endometrioma is detrimental to the ovaries [ 6 , 11 ]. The endometrioma, different from endometriosis, likely has specific impact on IVF/ICSI outcomes. Therefore, the first part of this study was aimed to compare IVF/ICSI outcomes between women with endometrioma and women with endometriosis. In the second part of our study, we aimed todetermine the impact of cystectomy on IVF/ICSI outcomes. Current guidelines are unclear regarding surgical removal of endometrioma prior to IVF/ICIS [ 12 ]. Surgical treatment of endometrioma has been shown to increase natural fecundity [ 13 ]. And endometrioma left in situ during IVF/ICSI may cause technical difficulties during oocyte retrieval, progression of the endometrioma after ART,and higher risks of infection [ 14 – 16 ]. Evidence showed surgical treatment on endometrioma could be detrimental to ovarian reserve [ 17 , 18 ], subsequently adversely affecting reproductive outcomes of IVF/ICSI [ 19 ]. Therefore, the second part of our study was aimed todetermine the impact of cystectomy of endometrioma on the IVF/ICSI outcomes. Materials And Methods We retrospectively analyzed patients (n = 2,153) who had IVF/ICSI between January 2014 and December 2018, at Center for Reproductive Medicine, Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology and Women’s Health, Taichung Veterans General Hospital, Taichung, Taiwan. We included those cycles with patients’ major reason for IVF/ICSI is endometriosis. Endometriosis was confirmed by laparoscopic surgery, presence of endometrioma or pelvic examination revealed cul-de-sac nodularity with dysmenorrhea. Endometrioma was defined by visualizing, on two or more separate examinations done at intervals of at least one month apart, an ovarian cyst with regular margins and ground-glass echogenicity on transvaginal ultrasonography (TVUS) [ 20 ]. The endometrioma was measured along three dimensions, and the average diameter was calculated during a baseline ultrasonography on D2/D3 in the month of controlled ovarian stimulation (COS). We excluded those cycles with patients aged > 40 years, or < 20 years, simulation duration < 5 days, with severe male factor, uterine factor (including adenomyosis, defined by TVUS) or immunological factors. Patients whose embryos were not completely transferred back, or received embryo transfer from different OPU cycles were also excluded. The control group included women who underwent IVF/ICSI for non-endometriosis-related infertility during the same study period. Endometriosis was ruled out in a pre-ART work-up assessment, including clinical examination, questioning (regarding the extent of pelvic pain and a prior history of surgery) and TVUS. The control group was matched in age and AMH level in 1 to 3 subjects ratio. Blind matching to the results was performed. In the first analysis, we compared reproductive outcomes among patients with endometrioma present during the IVF/ICSI treatment, those with only endometriosis, and the control group. In the second analysis, we compared outcomes between patients with “Recurrent endometrioma group” defined as patients with endometrioma during IVF/ICSI, and history of cystectomy for endometrioma before, “Primary endometrioma group”, defined as who did not have cystectomy before and with endometrioma during IVF/ICSI, and “status post (s/p) cystectomy group” defined as patients received cystectomy for endometrioma before IVF/ICSI treatment and no presence with endometrioma during IVF/ICSI. This study was approved by the Institutional Review Board of the Taichung Veterans General Hospital (IRB No. CE21306B) Patients underwent COS, oocyte retrieval and embryo transfer according to procedures as previously described [ 21 ]. Which protocol (either agonist or antagonist protocol) to use for the patient was a discretion of the caring physician. Stimulation was monitored by transvaginal ultrasound. Ovulation triggering was induced by injecting the recombinant hCG (Ovidrel, Merck Serono) and or GnRH agonist. Ultrasound-guided transvaginal oocyte retrieval was carried out around 36 hours post-triggering. Oocytes were either inseminated or underwent ICSI approximately 4 hours after collection. For the fresh group, cleavage stage embryos or blastocysts were transferred. The surplus embryos were cryopreserved through vitrification. The endometrial preparations in the following FET cycles were programmed by either hormone replacement cycles or modified natural cycles, depending on individual conditions of patients. Details of the endometrium priming and luteal phase support have been reported earlier [ 21 ]. Outcomes and statistical analyses We followed up patients through June 2021. Our primary outcome was cumulative live birth rate (CLBR), determined in those achieved through fresh and/or vitrified embryos obtained from the same oocyte retrieval cycle. Clinical pregnancy was defined as the presence of at least one embryo with cardiac activity. Live birth was defined as the delivery of a live infant after at least 24 weeks of gestation. LBRs were calculated individually in the fresh ET cycle and in the first FET cycle if no fresh ET had been performed. Blastocyst formation rate only included those patients intended to receive blastocyst transfer. Data were presented as mean ± standard deviation (SD), or as percentage. Group comparisons were performed using Mann-Whitney and Pearson’s Chi square tests in SPSS (Version 18). Differences were considered significant at p < 0.05. Results We analyzed a total of 208 IVF/ICSI cycles with indications of endometriosis. These cycles consisted of 119 with endometriosis, and 89 with endometrioma. The flow chart of these cyclesare shown in Fig. 1 . In 89 cycles with endometrioma, 19 hadreceived cystectomy for endometrioma before IVF/ICSI,and were included in “recurrent endometrioma group”. Theremaining 64 cycles were included in “primary endometrioma group”. In 119 cycles with no endometrioma during IVF/ICSI, 40had received cystectomy for endometrioma before,and they were included in “s/p cystectomy group”. After matching,we had 624 cycles without endometriosis during IVF/ICSI, as control group. First analysis of the baseline characteristics and outcomes are presented in Table 1 . Comparable characteristics in the endometriosis (A), endometrioma (B) and control (C) groups included the female age, serum AMH and stimulation protocol. Patients in the control group had a significantly higher BMI (20.9 \(\pm\) 2.5 versus 21.3 \(\pm\) 3.0 versus 22.3 \(\pm\) 3.6; p = 0.351n in A versus B, p< 0.001 in A versus C, p= 0.019 in B versus C). Significantly more patients in the control group received ICSI (27.2% versus 33.7% versus 46.4%; p = 0.353n in A versus B, p < 0.001 in A versus C, p = 0.022 in B versus C). In the endometrioma group, the mean size of endometrioma was 3.9 cm (range 1 to 9 cm). Table 1 showed baseline characteristics and results of the first anlalysis A.Endometriosis (n = 119) B.Endometrioma (n = 89) C. Control (n = 624) A vs. B P value A vs. C P value B vs. C P value Female age (y; mean ± SD) 34.1 \(\pm\) 3.1 34.4 \(\pm\) 3.5 34.3 \(\pm\) 3.1 0.564 0.523 0.884 BMI 20.9 \(\pm\) 2.5 21.3 \(\pm\) 3.0 22.3 \(\pm\) 3.6 0.351 < 0.001* 0.019* AMH (ng/ml) 3.6 \(\pm\) 2.9 3.1 \(\pm\) 2.5 3.5 \(\pm\) 3.1 0.155 0.449 0.334 Stimulation protocol: Agonist protocol 33/119 (27.7%) 26/89 (29.2%) 158/624 (25.3%) 0.814 0.581 0.432 Antagonist protocol 86/119 (72.3%) 63/89 (70.8%) 466/624 (74.4%) Fertilization method: ICSI 33/199 (27.7%) 30/89(33.7%) 291/624 (46.4%) 0.353 < 0.001* 0.022* IVF 86/199(72.3%) 59/89(66.3%) 333/624 (53.4%) Total FSH dosage (IU) 3047.3 \(\pm\) 1037.9 3619.4 \(\pm\) 1223 3130 \(\pm\) 1065.5 0.001* 0.400 0.001 Total LH dosage (IU) 941.0 \(\pm\) 573.9 1224.4 \(\pm\) 721.5 963 \(\pm\) 601.2 0.009* 0.823 0.003* Stimulation days 9.9 \(\pm\) 1.6 10.3 \(\pm\) 2.3 10.1 \(\pm\) 1.5 0.326 0.188 0.912 Endometrium(mm), trigger day 11.2 \(\pm\) 2.8 11.9 \(\pm\) 3.4 11.0 \(\pm\) 3.3 0.028* 0.699 0.004* Total ≥ 14mm follicle number 8.5 \(\pm\) 4.7 7.6 \(\pm\) 4.8 9.1 \(\pm\) 5.7 0.147 0.595 0.028* E2 on trigger day (pg/ml) 2779.3 \(\pm\) 1753.7 2602.1 \(\pm\) 2151.9 2799.6 \(\pm\) 1993.9 0.168 0.659 0.172 P4 on trigger day (ng/ml) 0.9 \(\pm\) 0.4 1.0 \(\pm\) 0.7 1.0 \(\pm\) 0.6 0.801 0.668 1.000 Number of oocyte retrieval 12.4 \(\pm\) 8.4 10.3 \(\pm\) 6.7 12.7 \(\pm\) 8.5 0.131 0.624 0.017* Number of mature oocytes 9.6 \(\pm\) 6.6 8.0 \(\pm\) 5.8 10.0 \(\pm\) 7.1 0.121 0.552 0.013* Fertilization rate 74.2% 73.8% 69.3% 0.219 0.613 0.28 Good embryos rate at D3 32.0% 31.4% 34.7% 0.780 0.100 0.098 BC formation rate 57.7% 49.4% 56% 0.005* 0.376 0.008* D2/D3 embryo transfer rate 58.9% 71.1% 69.1% 0.181 0.088 0.783 EMT: endometrial thickness *with statistical significance Table 2 baseline characteristics and results of the second analysis D. Primary Endometrioma (n = 70) E. s/p Cystectomy (n = 40) F. Recurrent endometrioma (n = 19) D vs.E P value D vs. F P value E vs. F P value Female age (mean ± SD) 34.6 \(\pm\) 3.6 32.8 \(\pm\) 3.4 33.4 \(\pm\) 2.8 0.007* 0.057 0.744 BMI 21 \(\pm\) 2.6 20.7 \(\pm\) 2.1 22.4 \(\pm\) 4 0.598 0.196 0.164 AMH (ng/ml) 3.2 \(\pm\) 2.5 3.4 \(\pm\) 2.8 2.7 \(\pm\) 2.5 0.828 0.277 0.239 Stimulation protocol: Agonist protocol 22/70 (31.4%) 8/40 (20.0%) 4/19 (21.1%) 0.195 0.378 0.925 Antagonist protocol 48/70 (68.6%) 32/40(80.0%) 15/19 (787.9%) Fertilization method ICSI 26/70 (37.1%) 10/40 (25%) 4/19 (21.1%) 0.192 0.188 0.793 IVF 44/70 (62.9%) 30/40 (75%) 15/19 (78.9%) Total dose of FSH (IU) 3561.9 \(\pm\) 1211.4 2844.0 \(\pm\) 1109.2 3820.8 \(\pm\) 1277.3 0.001* 0.47 0.004* Total dose of LH (IU) 1207.5 \(\pm\) 718.8 915 \(\pm\) 642.8 1286.8 \(\pm\) 747.6 0.03* 0.722 0.090 Stimulation days 10.5 \(\pm\) 2.4 9.3 \(\pm\) 1.5 9.8 \(\pm\) 1.7 0.012* 0.33 0.421 EMT (mm) on trigger day 11.9 \(\pm\) 3.6 11.2 \(\pm\) 2.6 12 \(\pm\) 2.7 0.091 0.798 0.303 No. of follicle ≥ 14mm on trigger day 8.0 \(\pm\) 4.8 7.5 \(\pm\) 4.5 5.9 \(\pm\) 4.9 0.575 0.045* 0.154 E2 on trigger day (pg/ml) 2771 \(\pm\) 2146.4 2677.8 \(\pm\) 1831.5 1976.5 \(\pm\) 2110.4 0.744 0.298 0.043* P4 on trigger day (ng/ml) 1.0 \(\pm\) 0.7 0.8 \(\pm\) 0.4 0.9 \(\pm\) 0.4 0.4 0.814 0.709 No. of oocyte retrieval 10.6 \(\pm\) 6.6 11 \(\pm\) 8.5 8.9 \(\pm\) 7.4 0.592 0.191 0.342 No. of mature oocyte 8.3 \(\pm\) 5.7 8.6 \(\pm\) 6.6 6.7 \(\pm\) 6.3 0.753 0.112 0.272 Fertilization rate 73.4% 78.2% 73% 0.64 0.155 0.286 Good embryos rate on D3 31.2% 35% 32.4% 0.268 0.823 0.630 BC formation rate 49.7% 61.5% 47.8% 0.004* 0.690 0.042* D2/D3 embryo transfer rate 69.4% 69.6% 77.8% 1.00 1.00 1.00 * With statistical significance The used gonadotropin dose was significantly higher in the endometrioma group compared with other groups (FSH dosage 3047 \(\pm\) 1037.9 IU versus 3619IU \(\pm\) 1223 versus 3130 \(\pm\) 1065.5 IU, p = 0.001 in A versus B, p= 0.4 in A versus C, p= 0.001 in B versus C; LH dosage 941 \(\pm\) 573.9 IU versus 1224 \(\pm\) 721.5 IU versus 963 \(\pm\) 601.2 IU, p = 0.009 in A versus B, p = 0.823 in A versus C, p = 0.003 in B versus C). The number of follicles ≥ 14 mm on the day of triggering, number of oocytes retrieved, and number of mature oocytes were lower in the endometrioma group than control. The blastocyst formation rate was significantly lower in the endometrioma group compared with other two groups (57.7% versus 49.4% versus 56% p = 0.005 in A versus B, p = 0.376 in A versus C, p = 0.008 in B versus C). CPR in fresh ET, LBR in fresh ET, and CLBR were comparable in the three groups. LBR in first FET in freeze-all cycle was significantly lower in the endometrioma group compared with the control group (53.8% versus 36.8% versus 59.2% p = 0.134 in A versus B, p = 0.536 in A versus C, p = 0.011 in B versus C) (Fig. 2 ). In the second analysis, the baseline characteristics and clinical outcomes of primary endometrioma (D), s/p cystectomy (E) and recurrent endometrioma (F) are shown in Table 3. The female age was lower in the s/p cystectomy group than endometrioma group (34.6 \(\pm\) 3.6 versus 32.8 \(\pm\) 3.4, p = 0.007). Serum AMH, BMI, stimulation protocol and fertilization method were similar in each groups. Total usage gonadotropin dose and length of COS were lower in the s/p cystectomy group (FHS dose 3561.9 \(\pm\) 1211.4 IU versus 2844 IU \(\pm\) 1109.2 versus 3820.8 \(\pm\) 1277.3 IU in group D, E, F, p = 0.001 in D versus E, p = 0.47 in D versus F, p= 0.004 in E versus F; LH dose 1207.5 \(\pm\) 718.8 versus 915 \(\pm\) 642.8 versus 1286.8 \(\pm\) 747.6, p = 0.03 in D versus E, p = 0.722 in D versus F, p = 0.09 in E versus F; length of stimulation 10.5 \(\pm\) 2.4 versus 9.3 \(\pm\) 1.5 versus 9.8 \(\pm\) 1.7, p = 0.012 in D versus E, p = 0.33 in D versus F, p= 0.421 in E versus F). The number of follicles measuring ≥ 14 mm on the day of triggering and estradiol level were lower in the recurrent endometrioma group. The blastocyst formation rate was highest in the s/p cystectomy group (49.7% versus 61.5% versus 47.8%, p = 0.004 in D versus E, p = 0.69 in D versus F, p= 0.042 in E versus F). CPR in fresh ET, LBR in fresh ET, LBR in first FTE in freeze-all cycle and CLBR were similar in primary endometrioma, s/p cystectomy and recurrent endometrioma groups (Fig. 3 ). Discussion Our results showed that in patients with endometriosis being the major indication for IVF/ICSI, the CLBR were similar to controls (non-endometriosis). Although the presence of endometriomahad comparable CLRB, the used gonadotropin dose was significantly higher, and the blastocyst formation ratewas significantly lower compared with those patientswith only endometriosis. In the second analysis, CLBR were comparableacross primary endometrioma, s/p cystectomy and recurrent endometrioma groups. The blastocyst formation rate was significantly higher in the s/p cystectomy group compared with the other two groups. A number of studies investigated effects of endometriosis on ART outcomes.In general, women with endometriosis have similar ART outcomes to those of controls in terms of LBR [ 22 – 24 ].Our results are compatible with these.Regarding the relationship between the presence of endometrioma and ART outcomes,findings are less consistent. A recent systematic review found women with endometrioma only have fewer oocytes and MII oocytes retrieved when compared tothose without endometriosis, but no such differences in CPR, IR and LBR [ 25 ]. Our result is similar to theirs, showing that endometrioma was associated with higher gonadotropin consumption, lower number of oocytes retrieved, and lower blastocyst formation rate, when compared with controls. The final outcome, CLBR, wasthe same as the control group. When comparing between patients with endometrioma and with endometriosis, our results on outcomes revealed the similarities of LBR and CLBR in patients with endometrioma or with endometriosis. These findings are consistent with previous studies showing similarity in delivery rates and pregnancy rates in patients with unoperated endometrioma and with only endometriosis [26.27]. These studies were however conducted in 2000s, and CLBR was not analyzed. In comparing primary endometriomaand cystectomy before IVF/ICSI,wefound that although the s/p cystectomy group were younger in age,their ovarian reserves were similar,likely due to surgical excision of endometrioma lowering the ovarian reserve [ 17 ]. In our center, our policy is to choose younger patients with moderate ovarian reserve to receive cystectomy for endometrioma for fertility reason.We had encouraged these patients to undergo IVF/ICSI ifnot get pregnancy after trail of one year after operation.Despite concerns of reduced ovarian reserve, surgical removal of endometrioma may improve chances of spontaneous pregnancy by restoring the ovarian functional anatomy.This approach has been considered a primary treatment for infertility in the case of endometrioma [ 12 ]. Alsosuch operation improves pain symptoms [ 28 ].Regarding the impact of excised endometrioma on ART outcomes, we found similarities between the primary endometrioma and s/p cystectomy groups interms of the number of oocyte retrieval, number of mature oocytes, LBR and CLBR.Our findings are consistent with most reports in the literature, including a recent meta-analysis [ 29 ].Other studies reported differentresults that endometrioma surgery diminishing ovarian reserve, leading to lower pregnancy rates in IVF [30.31]. However, these studies were conducted on limited numbers of patients, with differences surgical procedure and surgeon's expertise. Our results including CLBR per oocyte retrieval further confirmed thatwith comparable ovarian reserves, cystectomy before operationproduced similar IVF/ICSI outcomes compared with endometrioma in situ . In comparing primary and recurrent endometriomas, our results showedweaker ovarian responses to COS in the recurrent endometrioma group. This finding is inconsistent with a previous study, whichreported patients with recurrent endometriomas have the same ovarian response [ 32 ]. Incontrast, the outcomes of IVF/ICSI including LBR and CLBR in our study were compatible between these two groups, and was consistent with this study [ 32 ].There were study histologically confirmed surgery for recurrent endometrioma is associated with greater loss of ovarian tissue, which is more harmful to ovarian reserve compared with endometriomas operated for the first time [ 33 ]. Park et al ., also reported that second-line surgery for recurrent endometrioma have deleterious effects on IVF outcomes, including ovarian response, and CPR compared with in situ recurrent endometrioma [ 34 ]. It wasalso reported that spontaneous cumulative pregnancy rate is almost half after second-line surgery for endometrioma comparing with those obtained after primary surgery [ 35 ]. Therefore, a conservative management for recurrent endometrioma is more suitable for women with fertility desire. Our study showed presence of endometrioma was associated withfewer blastocyst formations, compared with the endometriosis or control group.Such effects seemed to disappear after cystectomy of endometrioma. The poorer ovarian response and lower blastocyst formation rate wereunlikely consequences of deleterious effects of surgery on the endometriomas, but more likely due to endometrioma per se . There are growing studies showed ovarian quality may be deteriorated by endometrioma [ 36 ]. One recent study using scRNA-seq compared oocytes from patients with endometrioma and healthy oocytes revealed a differential transcriptomic profile indicating lower oocyte quality in endometrioma [ 37 ]. These mechanisms may explain how blastocyst formation rate we found was lower in the endometrioma group. Our study has some strengths. First, our primary outcome is CLBR per oocyte retrieval which was seldom mentioned in previous studies, and was a better indicator of quality and success in IVF/ICSI, as cryopreservation is an integral part of IVF [ 38 ]. Second, all our patients had undergone ovarian stimulation and IVF performed at a single medical center. In this regard, all measurements (AMH and TVUS) were performed consistently. Third, we had compared presence of endometrioma with endometriosis. This issue is not commonly addressed, but has practical implications. Our results showed for the first time, that the presence of endometrioma negatively influenced ovarian responsiveness and blastocyst formation rate. The main limitation of this work is its retrospective design nature. In addition, the endometriosis group is heterogeneous, including patients with peritoneal endometriosis or DIE, and some of them have no pathological diagnosis. Nevertheless, it is nowadays well accepted that the TVUS is a highly accurate and reproducible method for non-invasive diagnosis of DIE and ovarian lesions [ 39 ]. Another limitation is that we did not stratified patients according to their endometriosis stages, and only stratified those with endometrioma or endometriosis. As increasing number of patients are receiving conservative treatment before IVF/ICSI, the presence or absence of endometrioma is a more useful characteristic in daily practice. In conclusion,we showed the IVF/ICSI outcomesare comparable in those with endometriomaand in controls. Although blastocyst formation rate was lower and gonadotropin consumption was higher in thosewith endometrioma, IVF/ICSI outcomes of patients with endometriomawere no worse than those with endometriosis. Cystectomy for endometrioma did not alter the IVF/ICSI outcomes if the ovarian reserve was comparable. Recurrent endometrioma did notshow worse impacts on the IVF/ICSI outcomecompared with primary endometrioma. Declarations Ethics approval and consent to participate : Institutional Review Board, TCVGH, No. CE21306B Date of approval: August 30, 2021 Consent for publication: Not Applicable Availability of data and materials: All data generated or analysed during this study are included in this published article [and its supplementary information files. Competing interests: Not Applicable Funding : No funding was obtained for this study Authors' contributions: Jui-Chun Chang and Ming-Jer Chen wrote the main manuscript text Hsiao-Fan Kung. and Yu-Chiao Yi. prepared figures and tables. Hwa-Fen Guu and Li-Yu Chen collect the data Ya-Fang Chen and Shih-Ting Chuan do the statistics All authors reviewed the manuscript." Acknowledgments : Not Applicable References Holoch, K. J. and B. A. Lessey. "Endometriosis and infertility." Clin Obstet Gynecol2010 53: 429–438. Macer, M. L. and H. S. Taylor. 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"Is the oocyte quality affected by endometriosis? A review of the literature." J Ovarian Res2017; 10: 43. Dunselman, G. A., N. Vermeulen, C. Becker, C. Calhaz-Jorge, T. D'Hooghe, B. De Bie, O. Heikinheimo, A. W. Horne, L. Kiesel, A. Nap, A. Prentice, E. Saridogan, D. Soriano and W. Nelen "ESHRE guideline: management of women with endometriosis." Hum Reprod 2014;29: 400–412. Vercellini, P., E. Somigliana, R. Daguati, G. Barbara, A. Abbiati and L. Fedele. "The second time around: reproductive performance after repetitive versus primary surgery for endometriosis." Fertil Steril 2009;92: 1253–1255. Benaglia, L., E. Somigliana, R. Iemmello, E. Colpi, A. E. Nicolosi and G. Ragni. "Endometrioma and oocyte retrieval-induced pelvic abscess: a clinical concern or an exceptional complication?" Fertil Steril 2008;89: 1263–1266. Nieweglowska, D., I. Hajdyla-Banas, K. Pitynski, T. Banas, O. Grabowska, G. Juszczyk, A. Ludwin and R. Jach. "Age-related trends in anti-Mullerian hormone serum level in women with unilateral and bilateral ovarian endometriomas prior to surgery." Reprod Biol Endocrinol 2015;13: 128. Somigliana, E., L. Benaglia, A. Paffoni, A. Busnelli, P. Vigano and P. Vercellini. "Risks of conservative management in women with ovarian endometriomas undergoing IVF." Hum Reprod Update 2015;21: 486–499. Younis, J. S., N. Shapso, R. Fleming, I. Ben-Shlomo and I. Izhaki "Impact of unilateral versus bilateral ovarian endometriotic cystectomy on ovarian reserve: a systematic review and meta-analysis." Hum Reprod Update2019; 25: 375–391. Ergun, B., M. Ozsurmeli, O. Dundar, C. Comba, O. Kuru and S. Bodur. "Changes in Markers of Ovarian Reserve After Laparoscopic Ovarian Cystectomy." J Minim Invasive Gynecol 2015;22: 997–1003. Benschop, L., C. Farquhar, N. van der Poel and M. J. Heineman. "Interventions for women with endometrioma prior to assisted reproductive technology." Cochrane Database Syst Rev2010 (11): Cd008571. Exacoustos, C., L. Manganaro and E. Zupi. "Imaging for the evaluation of endometriosis and adenomyosis." Best Pract Res Clin Obstet Gynaecol 2014;28: 655–681 Jui-Chun Chang, Ming-Jer Chen, Hwa-Fen Guu, Ya-Fang Chen, Yu-Chiao Yi, Hsiao-Fan Kung, Li-Yu Chen, Min-Min Chou Does the “freeze-all” policy allow for a better outcome in assisted reproductive techniques than the use of fresh embryo transfers? A retrospective study Senapati, S., M. D. Sammel, C. Morse and K. T. Barnhart. "Impact of endometriosis on in vitro fertilization outcomes: an evaluation of the Society for Assisted Reproductive Technologies Database." Fertil Steril 2016;106: 164–171 Prefumo, F. and A. C. Rossi "Endometriosis, endometrioma, and ART results: Current understanding and recommended practices." Best Pract Res Clin Obstet Gynaecol 2018; 51: 34–40. Rossi, A. C. and F. Prefumo. "The effects of surgery for endometriosis on pregnancy outcomes following in vitro fertilization and embryo transfer: a systematic review and meta-analysis." Arch Gynecol Obstet 2016;294: 647–655. Alshehre SM, Narice BF, Fenwick MA, Metwally M. The impact of endometrioma on in vitro fertilisation/intra-cytoplasmic injection IVF/ICSI reproductive outcomes: a systematic review and meta-analysis. Arch Gynecol Obstet. 2021 Jan;303(1):3–16. Kuroda, K., M. Kitade, I. Kikuchi, J. Kumakiri, S. Matsuoka, M. Kuroda and S. Takeda. "The impact of endometriosis, endometrioma and ovarian cystectomy on assisted reproductive technology." Reprod Med Biol 2009;8: 113–118. Suzuki, T., S. Izumi, H. Matsubayashi, H. Awaji, K. Yoshikata and T. Makino. "Impact of ovarian endometrioma on oocytes and pregnancy outcome in in vitro fertilization." Fertil Steril 2005;83: 908–913. Leonardi, M., T. Gibbons, M. Armour, R. Wang, E. Glanville, R. Hodgson, A. E. Cave, J. Ong, Y. Y. F. Tong, T. Z. Jacobson, B. W. Mol, N. P. Johnson and G. Condous "When to Do Surgery and When Not to Do Surgery for Endometriosis: A Systematic Review and Meta-analysis." J Minim Invasive Gynecol 2020;27: 390–407. Wu, C. Q., A. Albert, S. Alfaraj, O. Taskin, G. M. Alkusayer, J. Havelock, P. Yong, C. Allaire and M. A. Bedaiwy "Live Birth Rate after Surgical and Expectant Management of Endometriomas after In Vitro Fertilization: A Systematic Review, Meta-Analysis, and Critical Appraisal of Current Guidelines and Previous Meta-Analyses." J Minim Invasive Gynecol 2019 26: 299–311. Maignien, C., P. Santulli, V. Gayet, M. C. Lafay-Pillet, D. Korb, M. Bourdon, L. Marcellin, D. de Ziegler and C. Chapron "Prognostic factors for assisted reproductive technology in women with endometriosis-related infertility." Am J Obstet Gynecol 2017;216: 280.e1-280.e9 Roustan, A., J. Perrin, M. Debals-Gonthier, O. Paulmyer-Lacroix, A. Agostini and B. Courbiere "Surgical diminished ovarian reserve after endometrioma cystectomy versus idiopathic DOR: comparison of in vitro fertilization outcome." Hum Reprod 2015;30: 840–847. Ata, B., S. Mumusoglu, K. Aslan, A. Seyhan, I. Kasapoglu, B. Avci, B. Urman, G. Bozdag and G. Uncu "Which is worse? Comparison of ART outcome between women with primary or recurrent endometriomas." Hum Reprod 2017;32:1427–1431. Muzii, L., C. Achilli, F. Lecce, A. Bianchi, S. Franceschetti, C. Marchetti, G. Perniola and P. B. Panici. "Second surgery for recurrent endometriomas is more harmful to healthy ovarian tissue and ovarian reserve than first surgery." Fertil Steril 2015;103: 738–743. Park, H., C. H. Kim, E. Y. Kim, J. W. Moon, S. H. Kim, H. D. Chae and B. M. Kang. "Effect of second-line surgery on in vitro fertilization outcome in infertile women with ovarian endometrioma recurrence after primary conservative surgery for moderate to severe endometriosis." Obstet Gynecol Sci 2015;58: 481–486. Vercellini, P., E. Somigliana, P. Viganò, A. Abbiati, G. Barbara and P. G. Crosignani. "Surgery for endometriosis-associated infertility: a pragmatic approach." Hum Reprod 2009;24: 254–269 Corachán A, Pellicer N, Pellicer A, Ferrero H. Novel therapeutic targets to improve IVF outcomes in endometriosis patients: a review and future prospects. Hum Reprod Update. 2021;27:923–972. Ferrero H, Corachan A, Aguilar A, Qui ~ nonero A, Carbajo-Garcia MC, Alama P, Tejera A, Taboas E, Munoz E, Pellicer A. Single-cell RNA sequencing of oocytes from ovarian endometriosis patients reveals a differential transcriptomic profile associated with lower quality. Hum Reprod 2019;34:1302–1312 Garrido, N., J. Bellver, J. Remohí, C. Simón and A. Pellicer. "Cumulative live-birth rates per total number of embryos needed to reach newborn in consecutive in vitro fertilization (IVF) cycles: a new approach to measuring the likelihood of IVF success." Fertil Steril 2011;96: 40–46. Exacoustos, C., E. Zupi and E. Piccione. "Ultrasound Imaging for Ovarian and Deep Infiltrating Endometriosis." Semin Reprod Med 2017;35: 5–24 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-1755432","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":114716223,"identity":"fa2a83e8-79dd-4c62-bcec-51b7794ad8e5","order_by":0,"name":"Jui-Chun Chang","email":"","orcid":"","institution":"Taichung Veterans General Hospital","correspondingAuthor":false,"prefix":"","firstName":"Jui-Chun","middleName":"","lastName":"Chang","suffix":""},{"id":114716224,"identity":"c4512aab-6dbb-41a3-90df-37ee0a789a91","order_by":1,"name":"Yu-Chiao Yi","email":"","orcid":"","institution":"Chung Shan Medical University","correspondingAuthor":false,"prefix":"","firstName":"Yu-Chiao","middleName":"","lastName":"Yi","suffix":""},{"id":114716225,"identity":"a3101ee4-1a46-4730-8970-90ddb96937eb","order_by":2,"name":"Ya-Fang Chen","email":"","orcid":"","institution":"Taichung Veterans General Hospital","correspondingAuthor":false,"prefix":"","firstName":"Ya-Fang","middleName":"","lastName":"Chen","suffix":""},{"id":114716226,"identity":"b2c54ff0-0dd7-4024-aa2d-109f0dcae284","order_by":3,"name":"Hwa-Fen Guu","email":"","orcid":"","institution":"Taichung Veterans General Hospital","correspondingAuthor":false,"prefix":"","firstName":"Hwa-Fen","middleName":"","lastName":"Guu","suffix":""},{"id":114716227,"identity":"af5903bd-5724-4874-8454-f9395c6aae3d","order_by":4,"name":"Hsiao-Fan Kung","email":"","orcid":"","institution":"Taichung Veterans General Hospital","correspondingAuthor":false,"prefix":"","firstName":"Hsiao-Fan","middleName":"","lastName":"Kung","suffix":""},{"id":114716228,"identity":"7c841c74-cd24-4390-a509-9e0632a6a48c","order_by":5,"name":"Li-Yu Chen","email":"","orcid":"","institution":"Taichung Veterans General Hospital","correspondingAuthor":false,"prefix":"","firstName":"Li-Yu","middleName":"","lastName":"Chen","suffix":""},{"id":114716229,"identity":"1ffaca82-7eb8-4fe5-a767-8968cb96a8dc","order_by":6,"name":"Shih-Ting Chuan","email":"","orcid":"","institution":"Taichung Veterans General Hospital","correspondingAuthor":false,"prefix":"","firstName":"Shih-Ting","middleName":"","lastName":"Chuan","suffix":""},{"id":114716230,"identity":"896263b6-6f78-48c0-9e06-47bd98da72cb","order_by":7,"name":"Ming-Jer Chen","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA40lEQVRIiWNgGAWjYDACZiCWAGIDBgbGB0Cah48ULcwGIC1sRNsGVM4G0spAUItuO+/hFxYV9+TN2XuPVX7NsZNhY2B++OgGHi1mh/nSLCTOFBvu7DmXdlt2WzLQYWzGxjl4tfCYGUi2JSQY3Mgxuy25jRmohYdNmrCWf0At99+YFUtuqydKi/EDyQaQLTxmjB+3HSbOFgaJYwmGG87kGEszbjvOw8ZMyC/nzxh/lqhJkDc4fsbw489t1fb87M0PH+PTAgRs0hJQFjMPmMSvHKzk4wcoi/EHYdWjYBSMglEwAgEAVKRCXkUvTGMAAAAASUVORK5CYII=","orcid":"","institution":"Taichung Veterans General Hospital","correspondingAuthor":true,"prefix":"","firstName":"Ming-Jer","middleName":"","lastName":"Chen","suffix":""}],"badges":[],"createdAt":"2022-06-14 03:14:12","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-1755432/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-1755432/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":23013411,"identity":"40def180-59ee-409b-ba8f-12494fd07356","added_by":"auto","created_at":"2022-06-23 17:09:15","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":45784,"visible":true,"origin":"","legend":"\u003cp\u003epatient flow chart, 208 cycles had major indication for ART with endometriosis is included. 89 of them presence with endometrioma during IVF/ICSI. 119 of them with no endometrioma during treatment. In cycle presence with endometrioma, 19 of them have cystectomy for endometrioma before (as recurrent endometrioma group). The rest of 64 did not have cystectomy before as primary endometrioma group. In cycle with no endometrioma during IVF/ICSI (119), 93 of them was diagnosed by LSC. And 40 of them have received cystectomy for endometrioma during LSC (as s/p cystectomy group), another 53 only use electrocauterization (EC) for peritoneal endometriosis\u003c/p\u003e","description":"","filename":"Fig1.png","url":"https://assets-eu.researchsquare.com/files/rs-1755432/v1/ff6375745d4a1c40320e2afe.png"},{"id":23013412,"identity":"0ca207ab-9593-432a-bf9a-03df3c9b2ea1","added_by":"auto","created_at":"2022-06-23 17:09:15","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":37568,"visible":true,"origin":"","legend":"\u003cp\u003eOutcome of IVF/ICSI in endometriosis group, endometrioma group and control group. There is no significant difference in terms of CPR in fresh ET cycle, LBR in fresh ET cycle, and cumulative LBR. The LBR of the first ET in freeze-all cycle is significantly higher in control group than in the endometrioma group.\u003c/p\u003e","description":"","filename":"Fig2.png","url":"https://assets-eu.researchsquare.com/files/rs-1755432/v1/0bf252cee69fbb857e772909.png"},{"id":23013413,"identity":"2b8b3cbc-f74a-4ef7-9d66-4de5ff76b53e","added_by":"auto","created_at":"2022-06-23 17:09:15","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":40001,"visible":true,"origin":"","legend":"\u003cp\u003eOutcomes of IVF/ICSI in primary endometrioma, s/p cystectomy and recurrent endometrioma group. There is no significant difference in terms of CPR, LBR and cumulative LBR\u003c/p\u003e","description":"","filename":"Fig3.png","url":"https://assets-eu.researchsquare.com/files/rs-1755432/v1/116389530ba87bde47645080.png"},{"id":23013417,"identity":"de54a678-368c-4e30-86bf-a053be26d72f","added_by":"auto","created_at":"2022-06-23 17:09:24","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":479171,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-1755432/v1/38ec29ee-45de-4c4a-b2b5-7446c3dde589.pdf"},{"id":23013414,"identity":"713ee201-2744-47de-a087-d316ef38a28e","added_by":"auto","created_at":"2022-06-23 17:09:18","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":479171,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-1755432/v1/2bea9608-2041-42c5-bad0-72f27272a3d3.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"What is the impact of endometrioma on IVF/ICSI outcomes in patients with endometriosis: A retrospective study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eEndometriosis is a chronic disease and is known to be detrimental to fertility [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Around 25\u0026ndash;50% of women with infertility may be affected by endometriosis, and 30\u0026ndash;50% of women with endometriosis have infertility [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. A significant number of women with endometriosis eventually seek IVF with or without ICSI for conception. An endometrioma is the formation of a cyst within the ovary with ectopic endometrial tissue lining [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. It is found in 17\u0026ndash;44% of patients with endometriosis [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. The exact mechanism by whichendometrioma causes infertility remains uncertain. Several proposed mechanisms include distorting tubo-ovarian anatomy [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e], reduction in the quality and quantity of developing follicles by anatomical proximity of the ovarian cyst to the nearby follicular pool [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e], and reduced ovarian reserve and embryo quality by local inflammation milieu, toxic content and oxidative damage [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAlthough with a higher cancel rate and lower oocyte retrieval, current evidence is that women with endometrioma have similar IVF/ICSI outcome in terms of live birth rate compared with those without endometriosis [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. However, there were few studies comparing IVF/ICSI outcomes between women with endometrioma and women with endometriosis. Current molecular, histological and morphological evidence suggested that endometrioma is detrimental to the ovaries [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. The endometrioma, different from endometriosis, likely has specific impact on IVF/ICSI outcomes. Therefore, the first part of this study was aimed to compare IVF/ICSI outcomes between women with endometrioma and women with endometriosis.\u003c/p\u003e \u003cp\u003eIn the second part of our study, we aimed todetermine the impact of cystectomy on IVF/ICSI outcomes. Current guidelines are unclear regarding surgical removal of endometrioma prior to IVF/ICIS [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Surgical treatment of endometrioma has been shown to increase natural fecundity [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. And endometrioma left\u003cem\u003ein situ\u003c/em\u003e during IVF/ICSI may cause technical difficulties during oocyte retrieval, progression of the endometrioma after ART,and higher risks of infection [\u003cspan additionalcitationids=\"CR15\" citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Evidence showed surgical treatment on endometrioma could be detrimental to ovarian reserve [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e], subsequently adversely affecting reproductive outcomes of IVF/ICSI [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Therefore, the second part of our study was aimed todetermine the impact of cystectomy of endometrioma on the IVF/ICSI outcomes.\u003c/p\u003e"},{"header":"Materials And Methods","content":"\u003cp\u003eWe retrospectively analyzed patients (n\u0026thinsp;=\u0026thinsp;2,153) who had IVF/ICSI between January 2014 and December 2018, at Center for Reproductive Medicine, Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology and Women\u0026rsquo;s Health, Taichung Veterans General Hospital, Taichung, Taiwan. We included those cycles with patients\u0026rsquo; major reason for IVF/ICSI is endometriosis. Endometriosis was confirmed by laparoscopic surgery, presence of endometrioma or pelvic examination revealed cul-de-sac nodularity with dysmenorrhea. Endometrioma was defined by visualizing, on two or more separate examinations done at intervals of at least one month apart, an ovarian cyst with regular margins and ground-glass echogenicity on transvaginal ultrasonography (TVUS) [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. The endometrioma was measured along three dimensions, and the average diameter was calculated during a baseline ultrasonography on D2/D3 in the month of controlled ovarian stimulation (COS). We excluded those cycles with patients aged\u0026thinsp;\u0026gt;\u0026thinsp;40 years, or \u0026lt;\u0026thinsp;20 years, simulation duration\u0026thinsp;\u0026lt;\u0026thinsp;5 days, with severe male factor, uterine factor (including adenomyosis, defined by TVUS) or immunological factors. Patients whose embryos were not completely transferred back, or received embryo transfer from different OPU cycles were also excluded.\u003c/p\u003e \u003cp\u003eThe control group included women who underwent IVF/ICSI for non-endometriosis-related infertility during the same study period. Endometriosis was ruled out in a pre-ART work-up assessment, including clinical examination, questioning (regarding the extent of pelvic pain and a prior history of surgery) and TVUS. The control group was matched in age and AMH level in 1 to 3 subjects ratio. Blind matching to the results was performed.\u003c/p\u003e \u003cp\u003eIn the first analysis, we compared reproductive outcomes among patients with endometrioma present during the IVF/ICSI treatment, those with only endometriosis, and the control group. In the second analysis, we compared outcomes between patients with \u0026ldquo;Recurrent endometrioma group\u0026rdquo; defined as patients with endometrioma during IVF/ICSI, and history of cystectomy for endometrioma before, \u0026ldquo;Primary endometrioma group\u0026rdquo;, defined as who did not have cystectomy before and with endometrioma during IVF/ICSI, and \u0026ldquo;status post (s/p) cystectomy group\u0026rdquo; defined as patients received cystectomy for endometrioma before IVF/ICSI treatment and no presence with endometrioma during IVF/ICSI. This study was approved by the Institutional Review Board of the Taichung Veterans General Hospital (IRB No. CE21306B)\u003c/p\u003e \u003cp\u003ePatients underwent COS, oocyte retrieval and embryo transfer according to procedures as previously described [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Which protocol (either agonist or antagonist protocol) to use for the patient was a discretion of the caring physician. Stimulation was monitored by transvaginal ultrasound. Ovulation triggering was induced by injecting the recombinant hCG (Ovidrel, Merck Serono) and or GnRH agonist. Ultrasound-guided transvaginal oocyte retrieval was carried out around 36 hours post-triggering. Oocytes were either inseminated or underwent ICSI approximately 4 hours after collection. For the fresh group, cleavage stage embryos or blastocysts were transferred. The surplus embryos were cryopreserved through vitrification. The endometrial preparations in the following FET cycles were programmed by either hormone replacement cycles or modified natural cycles, depending on individual conditions of patients. Details of the endometrium priming and luteal phase support have been reported earlier [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e \u003cem\u003eOutcomes and statistical analyses\u003c/em\u003e \u003c/p\u003e \u003cp\u003e We followed up patients through June 2021. Our primary outcome was cumulative live birth rate (CLBR), determined in those achieved through fresh and/or vitrified embryos obtained from the same oocyte retrieval cycle. Clinical pregnancy was defined as the presence of at least one embryo with cardiac activity. Live birth was defined as the delivery of a live infant after at least 24 weeks of gestation. LBRs were calculated individually in the fresh ET cycle and in the first FET cycle if no fresh ET had been performed. Blastocyst formation rate only included those patients intended to receive blastocyst transfer.\u003c/p\u003e \u003cp\u003eData were presented as mean\u0026thinsp;\u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003e\u0026plusmn;\u003c/span\u003e\u0026thinsp;standard deviation (SD), or as percentage. Group comparisons were performed using Mann-Whitney and Pearson\u0026rsquo;s Chi square tests in SPSS (Version 18). Differences were considered significant at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eWe analyzed a total of 208 IVF/ICSI cycles with indications of endometriosis. These cycles consisted of 119 with endometriosis, and 89 with endometrioma. The flow chart of these cyclesare shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. In 89 cycles with endometrioma, 19 hadreceived cystectomy for endometrioma before IVF/ICSI,and were included in \u0026ldquo;recurrent endometrioma group\u0026rdquo;. Theremaining 64 cycles were included in \u0026ldquo;primary endometrioma group\u0026rdquo;. In 119 cycles with no endometrioma during IVF/ICSI, 40had received cystectomy for endometrioma before,and they were included in \u0026ldquo;s/p cystectomy group\u0026rdquo;. After matching,we had 624 cycles without endometriosis during IVF/ICSI, as control group.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eFirst analysis of the baseline characteristics and outcomes are presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. Comparable characteristics in the endometriosis (A), endometrioma (B) and control (C) groups included the female age, serum AMH and stimulation protocol. Patients in the control group had a significantly higher BMI (20.9 \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\pm\\)\u003c/span\u003e\u003c/span\u003e 2.5 versus 21.3 \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\pm\\)\u003c/span\u003e\u003c/span\u003e 3.0 versus 22.3 \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\pm\\)\u003c/span\u003e\u003c/span\u003e 3.6; p\u0026thinsp;=\u0026thinsp;0.351n in A versus B, p\u0026lt; 0.001 in A versus C, p= 0.019 in B versus C). Significantly more patients in the control group received ICSI (27.2% versus 33.7% versus 46.4%; p\u0026thinsp;=\u0026thinsp;0.353n in A versus B, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001 in A versus C, p\u0026thinsp;=\u0026thinsp;0.022 in B versus C). In the endometrioma group, the mean size of endometrioma was 3.9 cm (range 1 to 9 cm).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eshowed baseline characteristics and results of the first anlalysis\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eA.Endometriosis (n\u0026thinsp;=\u0026thinsp;119)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eB.Endometrioma (n\u0026thinsp;=\u0026thinsp;89)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eC. Control\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;624)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eA vs. B\u003c/p\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eA vs. C\u003c/p\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eB vs. C\u003c/p\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale age (y; mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e34.1 \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\pm\\)\u003c/span\u003e\u003c/span\u003e3.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e34.4 \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\pm\\)\u003c/span\u003e\u003c/span\u003e 3.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e34.3 \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\pm\\)\u003c/span\u003e\u003c/span\u003e 3.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.564\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.523\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.884\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20.9 \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\pm\\)\u003c/span\u003e\u003c/span\u003e 2.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21.3 \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\pm\\)\u003c/span\u003e\u003c/span\u003e 3.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22.3 \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\pm\\)\u003c/span\u003e\u003c/span\u003e 3.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.351\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.019*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAMH (ng/ml)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.6 \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\pm\\)\u003c/span\u003e\u003c/span\u003e 2.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.1 \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\pm\\)\u003c/span\u003e\u003c/span\u003e 2.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.5 \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\pm\\)\u003c/span\u003e\u003c/span\u003e 3.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.155\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.449\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.334\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStimulation protocol:\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAgonist protocol\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e33/119 (27.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26/89 (29.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e158/624 (25.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.814\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.581\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.432\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAntagonist protocol\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e86/119 (72.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e63/89 (70.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e466/624 (74.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFertilization method:\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eICSI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e33/199 (27.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30/89(33.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e291/624 (46.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.353\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.022*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIVF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e86/199(72.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e59/89(66.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e333/624 (53.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal FSH dosage (IU)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3047.3\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\pm\\)\u003c/span\u003e\u003c/span\u003e1037.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3619.4\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\pm\\)\u003c/span\u003e\u003c/span\u003e1223\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3130\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\pm\\)\u003c/span\u003e\u003c/span\u003e1065.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.400\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal LH dosage (IU)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e941.0 \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\pm\\)\u003c/span\u003e\u003c/span\u003e 573.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1224.4\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\pm\\)\u003c/span\u003e\u003c/span\u003e721.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e963\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\pm\\)\u003c/span\u003e\u003c/span\u003e601.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.009*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.823\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.003*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStimulation days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9.9 \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\pm\\)\u003c/span\u003e\u003c/span\u003e 1.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.3 \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\pm\\)\u003c/span\u003e\u003c/span\u003e 2.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10.1\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\pm\\)\u003c/span\u003e\u003c/span\u003e 1.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.326\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.188\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.912\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEndometrium(mm), trigger day\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11.2 \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\pm\\)\u003c/span\u003e\u003c/span\u003e 2.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11.9 \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\pm\\)\u003c/span\u003e\u003c/span\u003e 3.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11.0 \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\pm\\)\u003c/span\u003e\u003c/span\u003e3.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.028*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.699\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.004*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026ge;\u003c/span\u003e\u0026thinsp;14mm follicle number\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8.5 \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\pm\\)\u003c/span\u003e\u003c/span\u003e 4.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.6 \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\pm\\)\u003c/span\u003e\u003c/span\u003e 4.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9.1 \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\pm\\)\u003c/span\u003e\u003c/span\u003e 5.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.147\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.595\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.028*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eE2 on trigger day (pg/ml)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2779.3\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\pm\\)\u003c/span\u003e\u003c/span\u003e1753.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2602.1\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\pm\\)\u003c/span\u003e\u003c/span\u003e 2151.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2799.6\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\pm\\)\u003c/span\u003e\u003c/span\u003e1993.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.168\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.659\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.172\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP4 on trigger day (ng/ml)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.9 \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\pm\\)\u003c/span\u003e\u003c/span\u003e 0.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.0 \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\pm\\)\u003c/span\u003e\u003c/span\u003e 0.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.0 \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\pm\\)\u003c/span\u003e\u003c/span\u003e 0.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.801\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.668\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of oocyte retrieval\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12.4 \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\pm\\)\u003c/span\u003e\u003c/span\u003e 8.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.3 \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\pm\\)\u003c/span\u003e\u003c/span\u003e 6.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12.7 \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\pm\\)\u003c/span\u003e\u003c/span\u003e 8.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.131\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.624\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.017*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of mature oocytes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9.6 \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\pm\\)\u003c/span\u003e\u003c/span\u003e 6.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8.0 \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\pm\\)\u003c/span\u003e\u003c/span\u003e 5.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10.0 \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\pm\\)\u003c/span\u003e\u003c/span\u003e7.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.121\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.552\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.013*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFertilization rate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e74.2%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e73.8%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e69.3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.219\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.613\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGood embryos rate at D3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e32.0%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31.4%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e34.7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.780\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.098\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBC formation rate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e57.7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e49.4%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e56%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.005*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.376\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.008*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eD2/D3 embryo transfer rate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e58.9%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e71.1%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e69.1%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.181\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.088\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.783\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c8\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003eEMT: endometrial thickness\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003e*with statistical significance\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ebaseline characteristics and results of the second analysis\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eD. Primary Endometrioma (n\u0026thinsp;=\u0026thinsp;70)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eE. s/p Cystectomy (n\u0026thinsp;=\u0026thinsp;40)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eF. Recurrent endometrioma\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;19)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eD vs.E\u003c/p\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eD vs. F\u003c/p\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eE vs. F\u003c/p\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale age (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e34.6 \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\pm\\)\u003c/span\u003e\u003c/span\u003e3.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32.8 \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\pm\\)\u003c/span\u003e\u003c/span\u003e 3.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e33.4\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\pm\\)\u003c/span\u003e\u003c/span\u003e2.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.007*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.057\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.744\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21 \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\pm\\)\u003c/span\u003e\u003c/span\u003e 2.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20.7 \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\pm\\)\u003c/span\u003e\u003c/span\u003e 2.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22.4 \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\pm\\)\u003c/span\u003e\u003c/span\u003e 4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.598\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.196\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.164\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAMH (ng/ml)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.2 \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\pm\\)\u003c/span\u003e\u003c/span\u003e 2.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.4 \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\pm\\)\u003c/span\u003e\u003c/span\u003e 2.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.7 \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\pm\\)\u003c/span\u003e\u003c/span\u003e 2.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.828\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.277\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.239\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStimulation protocol:\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAgonist protocol\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22/70 (31.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8/40 (20.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4/19 (21.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.195\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.378\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.925\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAntagonist protocol\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e48/70 (68.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32/40(80.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15/19 (787.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFertilization method\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eICSI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26/70 (37.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10/40 (25%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4/19 (21.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.192\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.188\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.793\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIVF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e44/70 (62.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30/40 (75%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15/19 (78.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal dose of FSH (IU)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3561.9\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\pm\\)\u003c/span\u003e\u003c/span\u003e1211.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2844.0\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\pm\\)\u003c/span\u003e\u003c/span\u003e1109.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3820.8\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\pm\\)\u003c/span\u003e\u003c/span\u003e1277.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.004*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal dose of LH (IU)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1207.5\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\pm\\)\u003c/span\u003e\u003c/span\u003e718.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e915 \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\pm\\)\u003c/span\u003e\u003c/span\u003e 642.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1286.8\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\pm\\)\u003c/span\u003e\u003c/span\u003e747.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.03*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.722\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.090\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStimulation days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10.5 \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\pm\\)\u003c/span\u003e\u003c/span\u003e2.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.3 \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\pm\\)\u003c/span\u003e\u003c/span\u003e 1.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9.8 \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\pm\\)\u003c/span\u003e\u003c/span\u003e 1.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.012*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.421\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEMT (mm) on trigger day\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11.9\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\pm\\)\u003c/span\u003e\u003c/span\u003e3.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11.2 \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\pm\\)\u003c/span\u003e\u003c/span\u003e 2.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12 \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\pm\\)\u003c/span\u003e\u003c/span\u003e 2.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.091\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.798\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.303\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo. of follicle\u0026thinsp;\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026ge;\u003c/span\u003e\u0026thinsp;14mm on trigger day\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8.0 \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\pm\\)\u003c/span\u003e\u003c/span\u003e 4.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.5 \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\pm\\)\u003c/span\u003e\u003c/span\u003e 4.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.9 \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\pm\\)\u003c/span\u003e\u003c/span\u003e 4.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.575\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.045*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.154\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eE2 on trigger day (pg/ml)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2771\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\pm\\)\u003c/span\u003e\u003c/span\u003e2146.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2677.8\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\pm\\)\u003c/span\u003e\u003c/span\u003e1831.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1976.5\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\pm\\)\u003c/span\u003e\u003c/span\u003e2110.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.744\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.298\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.043*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP4 on trigger day (ng/ml)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.0 \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\pm\\)\u003c/span\u003e\u003c/span\u003e 0.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.8\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\pm\\)\u003c/span\u003e\u003c/span\u003e 0.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.9 \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\pm\\)\u003c/span\u003e\u003c/span\u003e 0.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.814\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.709\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo. of oocyte retrieval\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10.6 \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\pm\\)\u003c/span\u003e\u003c/span\u003e 6.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\pm\\)\u003c/span\u003e\u003c/span\u003e 8.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8.9 \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\pm\\)\u003c/span\u003e\u003c/span\u003e 7.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.592\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.191\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.342\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo. of mature oocyte\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8.3 \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\pm\\)\u003c/span\u003e\u003c/span\u003e 5.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8.6\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\pm\\)\u003c/span\u003e\u003c/span\u003e6.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.7\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\pm\\)\u003c/span\u003e\u003c/span\u003e6.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.753\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.112\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.272\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFertilization rate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e73.4%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e78.2%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e73%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.155\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.286\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGood embryos rate on D3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31.2%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e32.4%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.268\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.823\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.630\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBC formation rate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e49.7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e61.5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e47.8%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.004*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.690\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e0.042*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eD2/D3 embryo transfer rate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e69.4%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e69.6%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e77.8%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003e* With statistical significance\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe used gonadotropin dose was significantly higher in the endometrioma group compared with other groups (FSH dosage 3047 \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\pm\\)\u003c/span\u003e\u003c/span\u003e1037.9 IU versus 3619IU \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\pm\\)\u003c/span\u003e\u003c/span\u003e1223 versus 3130\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\pm\\)\u003c/span\u003e\u003c/span\u003e1065.5 IU, p\u0026thinsp;=\u0026thinsp;0.001 in A versus B, p= 0.4 in A versus C, p= 0.001 in B versus C; LH dosage 941 \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\pm\\)\u003c/span\u003e\u003c/span\u003e 573.9 IU versus 1224\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\pm\\)\u003c/span\u003e\u003c/span\u003e721.5 IU versus 963\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\pm\\)\u003c/span\u003e\u003c/span\u003e601.2 IU, p\u0026thinsp;=\u0026thinsp;0.009 in A versus B, p\u0026thinsp;=\u0026thinsp;0.823 in A versus C, p\u0026thinsp;=\u0026thinsp;0.003 in B versus C). The number of follicles\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026ge;\u003c/span\u003e14 mm on the day of triggering, number of oocytes retrieved, and number of mature oocytes were lower in the endometrioma group than control. The blastocyst formation rate was significantly lower in the endometrioma group compared with other two groups (57.7% versus 49.4% versus 56% p\u0026thinsp;=\u0026thinsp;0.005 in A versus B, p\u0026thinsp;=\u0026thinsp;0.376 in A versus C, p\u0026thinsp;=\u0026thinsp;0.008 in B versus C).\u003c/p\u003e \u003cp\u003eCPR in fresh ET, LBR in fresh ET, and CLBR were comparable in the three groups. LBR in first FET in freeze-all cycle was significantly lower in the endometrioma group compared with the control group (53.8% versus 36.8% versus 59.2% p\u0026thinsp;=\u0026thinsp;0.134 in A versus B, p\u0026thinsp;=\u0026thinsp;0.536 in A versus C, p\u0026thinsp;=\u0026thinsp;0.011 in B versus C) (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eIn the second analysis, the baseline characteristics and clinical outcomes of primary endometrioma (D), s/p cystectomy (E) and recurrent endometrioma (F) are shown in Table\u0026nbsp;3. The female age was lower in the s/p cystectomy group than endometrioma group (34.6 \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\pm\\)\u003c/span\u003e\u003c/span\u003e3.6 versus 32.8 \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\pm\\)\u003c/span\u003e\u003c/span\u003e 3.4, p\u0026thinsp;=\u0026thinsp;0.007). Serum AMH, BMI, stimulation protocol and fertilization method were similar in each groups.\u003c/p\u003e \u003cp\u003eTotal usage gonadotropin dose and length of COS were lower in the s/p cystectomy group (FHS dose 3561.9 \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\pm\\)\u003c/span\u003e\u003c/span\u003e1211.4 IU versus 2844 IU\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\pm\\)\u003c/span\u003e\u003c/span\u003e1109.2 versus 3820.8\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\pm\\)\u003c/span\u003e\u003c/span\u003e1277.3 IU in group D, E, F, p\u0026thinsp;=\u0026thinsp;0.001 in D versus E, p\u0026thinsp;=\u0026thinsp;0.47 in D versus F, p= 0.004 in E versus F; LH dose 1207.5\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\pm\\)\u003c/span\u003e\u003c/span\u003e718.8 versus 915 \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\pm\\)\u003c/span\u003e\u003c/span\u003e 642.8 versus 1286.8\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\pm\\)\u003c/span\u003e\u003c/span\u003e747.6, p\u0026thinsp;=\u0026thinsp;0.03 in D versus E, p\u0026thinsp;=\u0026thinsp;0.722 in D versus F, p\u0026thinsp;=\u0026thinsp;0.09 in E versus F; length of stimulation 10.5 \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\pm\\)\u003c/span\u003e\u003c/span\u003e2.4 versus 9.3 \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\pm\\)\u003c/span\u003e\u003c/span\u003e 1.5 versus 9.8 \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\pm\\)\u003c/span\u003e\u003c/span\u003e 1.7, p\u0026thinsp;=\u0026thinsp;0.012 in D versus E, p\u0026thinsp;=\u0026thinsp;0.33 in D versus F, p= 0.421 in E versus F). The number of follicles measuring \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e\u0026ge;\u003c/span\u003e14 mm on the day of triggering and estradiol level were lower in the recurrent endometrioma group. The blastocyst formation rate was highest in the s/p cystectomy group (49.7% versus 61.5% versus 47.8%, p\u0026thinsp;=\u0026thinsp;0.004 in D versus E, p\u0026thinsp;=\u0026thinsp;0.69 in D versus F, p= 0.042 in E versus F).\u003c/p\u003e \u003cp\u003eCPR in fresh ET, LBR in fresh ET, LBR in first FTE in freeze-all cycle and CLBR were similar in primary endometrioma, s/p cystectomy and recurrent endometrioma groups (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eOur results showed that in patients with endometriosis being the major indication for IVF/ICSI, the CLBR were similar to controls (non-endometriosis). Although the presence of endometriomahad comparable CLRB, the used gonadotropin dose was significantly higher, and the blastocyst formation ratewas significantly lower compared with those patientswith only endometriosis. In the second analysis, CLBR were comparableacross primary endometrioma, s/p cystectomy and recurrent endometrioma groups. The blastocyst formation rate was significantly higher in the s/p cystectomy group compared with the other two groups.\u003c/p\u003e \u003cp\u003eA number of studies investigated effects of endometriosis on ART outcomes.In general, women with endometriosis have similar ART outcomes to those of controls in terms of LBR [\u003cspan additionalcitationids=\"CR23\" citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e].Our results are compatible with these.Regarding the relationship between the presence of endometrioma and ART outcomes,findings are less consistent. A recent systematic review found women with endometrioma only have fewer oocytes and MII oocytes retrieved when compared tothose without endometriosis, but no such differences in CPR, IR and LBR [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Our result is similar to theirs, showing that endometrioma was associated with higher gonadotropin consumption, lower number of oocytes retrieved, and lower blastocyst formation rate, when compared with controls. The final outcome, CLBR, wasthe same as the control group.\u003c/p\u003e \u003cp\u003eWhen comparing between patients with endometrioma and with endometriosis, our results on outcomes revealed the similarities of LBR and CLBR in patients with endometrioma or with endometriosis. These findings are consistent with previous studies showing similarity in delivery rates and pregnancy rates in patients with unoperated endometrioma and with only endometriosis [26.27]. These studies were however conducted in 2000s, and CLBR was not analyzed.\u003c/p\u003e \u003cp\u003eIn comparing primary endometriomaand cystectomy before IVF/ICSI,wefound that although the s/p cystectomy group were younger in age,their ovarian reserves were similar,likely due to surgical excision of endometrioma lowering the ovarian reserve [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. In our center, our policy is to choose younger patients with moderate ovarian reserve to receive cystectomy for endometrioma for fertility reason.We had encouraged these patients to undergo IVF/ICSI ifnot get pregnancy after trail of one year after operation.Despite concerns of reduced ovarian reserve, surgical removal of endometrioma may improve chances of spontaneous pregnancy by restoring the ovarian functional anatomy.This approach has been considered a primary treatment for infertility in the case of endometrioma [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Alsosuch operation improves pain symptoms [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e].Regarding the impact of excised endometrioma on ART outcomes, we found similarities between the primary endometrioma and s/p cystectomy groups interms of the number of oocyte retrieval, number of mature oocytes, LBR and CLBR.Our findings are consistent with most reports in the literature, including a recent meta-analysis [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e].Other studies reported differentresults that endometrioma surgery diminishing ovarian reserve, leading to lower pregnancy rates in IVF [30.31]. However, these studies were conducted on limited numbers of patients, with differences surgical procedure and surgeon's expertise. Our results including CLBR per oocyte retrieval further confirmed thatwith comparable ovarian reserves, cystectomy before operationproduced similar IVF/ICSI outcomes compared with endometrioma \u003cem\u003ein situ\u003c/em\u003e.\u003c/p\u003e \u003cp\u003eIn comparing primary and recurrent endometriomas, our results showedweaker ovarian responses to COS in the recurrent endometrioma group. This finding is inconsistent with a previous study, whichreported patients with recurrent endometriomas have the same ovarian response [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. Incontrast, the outcomes of IVF/ICSI including LBR and CLBR in our study were compatible between these two groups, and was consistent with this study [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e].There were study histologically confirmed surgery for recurrent endometrioma is associated with greater loss of ovarian tissue, which is more harmful to ovarian reserve compared with endometriomas operated for the first time [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. \u003cem\u003ePark et al\u003c/em\u003e., also reported that second-line surgery for recurrent endometrioma have deleterious effects on IVF outcomes, including ovarian response, and CPR compared with \u003cem\u003ein situ\u003c/em\u003e recurrent endometrioma [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. It wasalso reported that spontaneous cumulative pregnancy rate is almost half after second-line surgery for endometrioma comparing with those obtained after primary surgery [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. Therefore, a conservative management for recurrent endometrioma is more suitable for women with fertility desire.\u003c/p\u003e \u003cp\u003eOur study showed presence of endometrioma was associated withfewer blastocyst formations, compared with the endometriosis or control group.Such effects seemed to disappear after cystectomy of endometrioma. The poorer ovarian response and lower blastocyst formation rate wereunlikely consequences of deleterious effects of surgery on the endometriomas, but more likely due to endometrioma \u003cem\u003eper se\u003c/em\u003e. There are growing studies showed ovarian quality may be deteriorated by endometrioma [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. One recent study using scRNA-seq compared oocytes from patients with endometrioma and healthy oocytes revealed a differential transcriptomic profile indicating lower oocyte quality in endometrioma [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. These mechanisms may explain how blastocyst formation rate we found was lower in the endometrioma group.\u003c/p\u003e \u003cp\u003eOur study has some strengths. First, our primary outcome is CLBR per oocyte retrieval which was seldom mentioned in previous studies, and was a better indicator of quality and success in IVF/ICSI, as cryopreservation is an integral part of IVF [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. Second, all our patients had undergone ovarian stimulation and IVF performed at a single medical center. In this regard, all measurements (AMH and TVUS) were performed consistently. Third, we had compared presence of endometrioma with endometriosis. This issue is not commonly addressed, but has practical implications. Our results showed for the first time, that the presence of endometrioma negatively influenced ovarian responsiveness and blastocyst formation rate. The main limitation of this work is its retrospective design nature. In addition, the endometriosis group is heterogeneous, including patients with peritoneal endometriosis or DIE, and some of them have no pathological diagnosis. Nevertheless, it is nowadays well accepted that the TVUS is a highly accurate and reproducible method for non-invasive diagnosis of DIE and ovarian lesions [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. Another limitation is that we did not stratified patients according to their endometriosis stages, and only stratified those with endometrioma or endometriosis. As increasing number of patients are receiving conservative treatment before IVF/ICSI, the presence or absence of endometrioma is a more useful characteristic in daily practice.\u003c/p\u003e \u003cp\u003eIn conclusion,we showed the IVF/ICSI outcomesare comparable in those with endometriomaand in controls. Although blastocyst formation rate was lower and gonadotropin consumption was higher in thosewith endometrioma, IVF/ICSI outcomes of patients with endometriomawere no worse than those with endometriosis. Cystectomy for endometrioma did not alter the IVF/ICSI outcomes if the ovarian reserve was comparable. Recurrent endometrioma did notshow worse impacts on the IVF/ICSI outcomecompared with primary endometrioma.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e: Institutional Review Board, TCVGH, No. CE21306B\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; Date of approval: August 30, 2021\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication: \u003c/strong\u003eNot Applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials: \u003c/strong\u003eAll data generated or analysed during this study are included in this published article [and its supplementary information files.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u003c/strong\u003e Not Applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003cstrong\u003e: \u003c/strong\u003eNo funding was obtained for this study\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors' contributions:\u003c/strong\u003e\u0026nbsp; Jui-Chun Chang and Ming-Jer Chen wrote the main manuscript text\u003c/p\u003e\n\u003cp\u003eHsiao-Fan Kung. and Yu-Chiao Yi. prepared figures and tables.\u003c/p\u003e\n\u003cp\u003eHwa-Fen Guu and Li-Yu Chen collect the data\u003c/p\u003e\n\u003cp\u003eYa-Fang Chen and Shih-Ting Chuan do the statistics\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;All authors reviewed the manuscript.\"\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments \u003c/strong\u003e\u003cstrong\u003e: \u003c/strong\u003eNot Applicable\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eHoloch, K. 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Izhaki \"Impact of unilateral versus bilateral ovarian endometriotic cystectomy on ovarian reserve: a systematic review and meta-analysis.\" Hum Reprod Update2019; 25: 375\u0026ndash;391.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eErgun, B., M. Ozsurmeli, O. Dundar, C. Comba, O. Kuru and S. Bodur. \"Changes in Markers of Ovarian Reserve After Laparoscopic Ovarian Cystectomy.\" J Minim Invasive Gynecol 2015;22: 997\u0026ndash;1003.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBenschop, L., C. Farquhar, N. van der Poel and M. J. Heineman. \"Interventions for women with endometrioma prior to assisted reproductive technology.\" Cochrane Database Syst Rev2010 (11): Cd008571.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eExacoustos, C., L. Manganaro and E. Zupi. \"Imaging for the evaluation of endometriosis and adenomyosis.\" Best Pract Res Clin Obstet Gynaecol 2014;28: 655\u0026ndash;681\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJui-Chun Chang, Ming-Jer Chen, Hwa-Fen Guu, Ya-Fang Chen, Yu-Chiao Yi, Hsiao-Fan Kung, Li-Yu Chen, Min-Min Chou Does the \u0026ldquo;freeze-all\u0026rdquo; policy allow for a better outcome in assisted reproductive techniques than the use of fresh embryo transfers? A retrospective study\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSenapati, S., M. D. Sammel, C. Morse and K. T. Barnhart. \"Impact of endometriosis on in vitro fertilization outcomes: an evaluation of the Society for Assisted Reproductive Technologies Database.\" Fertil Steril 2016;106: 164\u0026ndash;171\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePrefumo, F. and A. C. Rossi \"Endometriosis, endometrioma, and ART results: Current understanding and recommended practices.\" Best Pract Res Clin Obstet Gynaecol 2018; 51: 34\u0026ndash;40.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRossi, A. C. and F. Prefumo. \"The effects of surgery for endometriosis on pregnancy outcomes following in vitro fertilization and embryo transfer: a systematic review and meta-analysis.\" Arch Gynecol Obstet 2016;294: 647\u0026ndash;655.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlshehre SM, Narice BF, Fenwick MA, Metwally M. The impact of endometrioma on in vitro fertilisation/intra-cytoplasmic injection IVF/ICSI reproductive outcomes: a systematic review and meta-analysis. Arch Gynecol Obstet. 2021 Jan;303(1):3\u0026ndash;16.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKuroda, K., M. Kitade, I. Kikuchi, J. Kumakiri, S. Matsuoka, M. Kuroda and S. Takeda. \"The impact of endometriosis, endometrioma and ovarian cystectomy on assisted reproductive technology.\" Reprod Med Biol 2009;8: 113\u0026ndash;118.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSuzuki, T., S. Izumi, H. Matsubayashi, H. Awaji, K. Yoshikata and T. Makino. \"Impact of ovarian endometrioma on oocytes and pregnancy outcome in in vitro fertilization.\" Fertil Steril 2005;83: 908\u0026ndash;913.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLeonardi, M., T. Gibbons, M. Armour, R. Wang, E. Glanville, R. Hodgson, A. E. Cave, J. Ong, Y. Y. F. Tong, T. Z. Jacobson, B. W. Mol, N. P. Johnson and G. Condous \"When to Do Surgery and When Not to Do Surgery for Endometriosis: A Systematic Review and Meta-analysis.\" J Minim Invasive Gynecol 2020;27: 390\u0026ndash;407.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWu, C. Q., A. Albert, S. Alfaraj, O. Taskin, G. M. Alkusayer, J. Havelock, P. Yong, C. Allaire and M. A. Bedaiwy \"Live Birth Rate after Surgical and Expectant Management of Endometriomas after In Vitro Fertilization: A Systematic Review, Meta-Analysis, and Critical Appraisal of Current Guidelines and Previous Meta-Analyses.\" J Minim Invasive Gynecol 2019 26: 299\u0026ndash;311.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMaignien, C., P. Santulli, V. Gayet, M. C. Lafay-Pillet, D. Korb, M. Bourdon, L. Marcellin, D. de Ziegler and C. Chapron \"Prognostic factors for assisted reproductive technology in women with endometriosis-related infertility.\" Am J Obstet Gynecol 2017;216: 280.e1-280.e9\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRoustan, A., J. Perrin, M. Debals-Gonthier, O. Paulmyer-Lacroix, A. Agostini and B. Courbiere \"Surgical diminished ovarian reserve after endometrioma cystectomy versus idiopathic DOR: comparison of in vitro fertilization outcome.\" Hum Reprod 2015;30: 840\u0026ndash;847.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAta, B., S. Mumusoglu, K. Aslan, A. Seyhan, I. Kasapoglu, B. Avci, B. Urman, G. Bozdag and G. Uncu \"Which is worse? Comparison of ART outcome between women with primary or recurrent endometriomas.\" Hum Reprod 2017;32:1427\u0026ndash;1431.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMuzii, L., C. Achilli, F. Lecce, A. Bianchi, S. Franceschetti, C. Marchetti, G. Perniola and P. B. Panici. \"Second surgery for recurrent endometriomas is more harmful to healthy ovarian tissue and ovarian reserve than first surgery.\" Fertil Steril 2015;103: 738\u0026ndash;743.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePark, H., C. H. Kim, E. Y. Kim, J. W. Moon, S. H. Kim, H. D. Chae and B. M. Kang. \"Effect of second-line surgery on in vitro fertilization outcome in infertile women with ovarian endometrioma recurrence after primary conservative surgery for moderate to severe endometriosis.\" Obstet Gynecol Sci 2015;58: 481\u0026ndash;486.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVercellini, P., E. Somigliana, P. Vigan\u0026ograve;, A. Abbiati, G. Barbara and P. G. Crosignani. \"Surgery for endometriosis-associated infertility: a pragmatic approach.\" Hum Reprod 2009;24: 254\u0026ndash;269\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCorach\u0026aacute;n A, Pellicer N, Pellicer A, Ferrero H. Novel therapeutic targets to improve IVF outcomes in endometriosis patients: a review and future prospects. Hum Reprod Update. 2021;27:923\u0026ndash;972.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFerrero H, Corachan A, Aguilar A, Qui ~ nonero A, Carbajo-Garcia MC, Alama P, Tejera A, Taboas E, Munoz E, Pellicer A. Single-cell RNA sequencing of oocytes from ovarian endometriosis patients reveals a differential transcriptomic profile associated with lower quality. Hum Reprod 2019;34:1302\u0026ndash;1312\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGarrido, N., J. Bellver, J. Remoh\u0026iacute;, C. Sim\u0026oacute;n and A. Pellicer. \"Cumulative live-birth rates per total number of embryos needed to reach newborn in consecutive in vitro fertilization (IVF) cycles: a new approach to measuring the likelihood of IVF success.\" Fertil Steril 2011;96: 40\u0026ndash;46.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eExacoustos, C., E. Zupi and E. Piccione. \"Ultrasound Imaging for Ovarian and Deep Infiltrating Endometriosis.\" Semin Reprod Med 2017;35: 5\u0026ndash;24\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Endometriosis, endometrioma, IVF/ICSI outcome, cystectomy, cumulative live birth rates","lastPublishedDoi":"10.21203/rs.3.rs-1755432/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-1755432/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eDoes endometrioma per se, different from endometriosis, have specific impacts on IVF/ICSI outcomes? Dose cystectomy of the endometrioma improve IVF/ICSI outcomes?\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eWe retrospectively analyzed 2153 IVF/ICSI cases treated during Jan/01/2014 to Dec/31/2020 in VGHTC. Two-hundred-and-eight women receiving IVF/ICSI treatment due to endometriosis. The control group consisted of 624 infertile women without endometriosis. First, we divided 208 patients into those with endometrioma (89) and those only with endometriosis (119). Second, we divided patients into primary endometrioma, recurrent endometrioma and those having received cystectomy for endometrioma before IVF/ICSI. Reproductive outcomes were compared.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eWe found in the endometrioma subgroup (B), the usage gonadotropin dose was significantly higher, and the blastocyst formation rate was significantly lower compared with endometriosis (A) and control group (C). The CLBR (60.5% versus 49.4% versus 56.9%, p\u0026thinsp;=\u0026thinsp;0.194 in A versus B, p\u0026thinsp;=\u0026thinsp;0.406 in A versus C, p\u0026thinsp;=\u0026thinsp;0.878 in B versus C) were comparable. From the second analysis, the blastocyst formation rate was significantly higher in the s/p cystectomy group. The CLBR were comparable (47.1%, 60% and 57.9% p\u0026thinsp;=\u0026thinsp;0.194 in D versus E, p\u0026thinsp;=\u0026thinsp;0.406 in D versus F, p\u0026thinsp;=\u0026thinsp;0.878 in E versus F, in primary endometrioma (D), s/p cystectomy (E) and recurrent endometrioma group (F)).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eAlthough the blastocyst formation rate was lower, and the usage gonadotropin dose was higher in the endometrioma group, CLBR was not worse than those with endometriosis or control. Cystectomy for endometrioma did not alter IVF/ICSI outcomes if ovarian reserve is comparable. Recurrent endometrioma did not worsen ART outcome than primary endometrioma.\u003c/p\u003e","manuscriptTitle":"What is the impact of endometrioma on IVF/ICSI outcomes in patients with endometriosis: A retrospective study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2022-06-23 17:09:13","doi":"10.21203/rs.3.rs-1755432/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"873d7e34-dd3d-4ba2-8b0f-d3bbf67ed1eb","owner":[],"postedDate":"June 23rd, 2022","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2022-06-28T12:59:10+00:00","versionOfRecord":[],"versionCreatedAt":"2022-06-23 17:09:13","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-1755432","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-1755432","identity":"rs-1755432","version":["v1"]},"buildId":"B-jG_2CBjPDmsCi4Wdhf-","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}