Topic- impact of laparoscopic cystectomy and endometrioma size on IVF outcomes: insights from a retrospective cohort study

Document Type

Article

Publication Title

Middle East Fertility Society Journal

Abstract

Background: Endometrioma, a common manifestation of endometriosis, can impact fertility and are often encountered in women undergoing assisted reproductive technologies (ART). Traditionally, surgical removal of endometriomas has been considered standard practice before in vitro fertilization (IVF). However, recent research questions whether surgery is necessary, as its benefits in improving IVF outcomes remain debated. The findings of present study contribute to the ongoing debate by examining both surgical management and cyst size as factors influencing IVF outcomes. The present study also aimed to use the Ovarian Sensitivity Index (OSI) as a dynamic marker of ovarian responsiveness to compare operated and non-operated endometriomas, a factor that has not been investigated in previous studies. Methods: This retrospective cohort study compared IVF outcomes between women with operated (n = 35) and non-operated (n = 48) endometriomas. We also evaluated the impact of endometrioma size (< 4 cm vs > 4 cm) on clinical outcomes. All participants were under 40 years of age and underwent their first cycle of IVF. The primary outcome was clinical pregnancy rate, while secondary outcomes included embryological parameters (total number of oocytes retrieved, mature oocytes, and good-quality embryos) and stimulation characteristics (total gonadotropin dose requirements and OSI). Statistical comparisons were made between the groups. Results: The total gonadotropin dose was significantly higher in the operated group (4050 IU vs. 3600 IU, p = 0.032). However, the number of oocytes, mature oocytes, and good-quality embryos were similar between operated and non-operated groups. Regarding cyst size, no significant differences in IVF outcomes were found between women with smaller (< 4 cm) and larger (> 4 cm) endometriomas. Conclusion: This study suggests that IVF outcomes are not significantly affected by the removal of endometriomas. While laparoscopic cystectomy may slightly increase gonadotropin requirements and potentially compromise ovarian reserve, it does not negatively impact IVF success rates. In asymptomatic patients, IVF can be successfully performed without the need for endometrioma removal, as the presence of the endometrioma does not appear to hinder IVF outcomes. Additionally, endometrioma size did not significantly influence IVF outcomes in this study. For women with symptomatic endometriomas, surgical intervention may still be considered, as it does not seem to deteriorate IVF outcomes, provided that careful patient selection is made.

DOI

10.1186/s43043-025-00265-2

Publication Date

12-1-2025

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