Significance of surgery for infertile patients with endometrioma

[Abstract] Background: The significance of cystectomy for infertile patients with endometrioma remains controversial.Methods: Between 1997 and 2013, 852 female patients visited Kindai University Hospital and were treated for infertility, and the significance of surgery for infertile patients with endometrioma was retrospectively analyzed in this study.Results: Among patients without endometrioma(N=740), patients with unilateral endometrioma(N=81), and patients with bilateral endometrioma(N=31), the proportion of patients with reduced ovarian reserve at the start of treatment was not different in patients <35 years old (5.0% vs 8.0% vs 10.5%, p=0.41) but was significantly different in patients 35 to 39 years old (15.6% vs 29.6% vs 45.5%, p=0.014). Among these three groups, the cumulative pregnancy rates in patients before surgery or in those who did not undergo surgery were significantly different in patients <35 years old (59.9% vs 27.3% vs 18.0%, p=0.008) and were not different in patients 35 to 39 years old (45.3% vs 38.0% vs 10.0%, p=0.93). Among the three groups, the cumulative pregnancy rates of patients who underwent surgery were not different in patients <35 years old (51.2% vs 45.2% vs 50.0%, p=0.71) but were significantly different in patients 35 to 39 years old (40.7% vs 31.3% vs 0%, p=0.025).Conclusions: Surgery, including cystectomy, for infertile patients with endometrioma improves fertility in patients <35 years old by correcting the pelvic environment to the same extent as that in patients without endometrioma but may decrease fertility in 35- to 39-year-old patients by reducing ovarian reserve.