Endometrioma, Fertility, and Assisted Reproduction

Towards more conservative management?

Key Points

Highlight:

• In this review, Dr. Garcia-Velasco group assess the latest findings concerning reproductive medicine, to support more conservative management of ovarian endometrioma.

Backgrounds:

• Endometriosis can negatively impact a woman’s health and quality of life.
• Patients struggling with endometriosis often pursue assisted reproductive technologies (ART) due to fertility issues.
• The management of ovarian endometrioma, which is the most prevalent phenotype, is challenging and controversial, especially in the context of ART.
• Surgery has been considered the primary treatment to overcome infertility in cases of ovarian endometrioma.

Key points:

• The presence of ovarian endometrioma per se is likely to impair ovarian reserve and alter ovarian functional anatomy.
• Surgical excision of ovarian endometrioma may affect ovarian reserve, especially in cases of bilateral and recurrent endometriomas.
• Surgery performed prior to ART may not improve reproductive outcomes.
• Controlled ovarian hyperstimulation (COH) does not always affect the quality of life or endometriosis-related pain symptoms.
• Some patients may exhibit a diminished ovarian response to COH, but the endometrial receptivity, aneuploidy rates, and fertility outcomes are generally similar to healthy controls.
• Nonetheless, endometrioma, whenever there is a suspicion of malignancy, bilaterality, along with the presence of clear indication for surgery, surgical excision and histopathological examination are indicated, regardless of the patient age.
  
  

Conclusions and discussions:

• The current evidence does not support the postponing infertility treatment in favor of surgery, except in cases with severe symptoms or to improve follicle accessibility.
• Less invasive approaches to ovarian endometrioma treatment must be further evaluated in randomized clinical trials.

Lay Summary

Endometriosis can negatively impact a woman’s health and quality of life. Surgery has been considered the primary treatment to overcome infertility in cases of ovarian endometrioma. Patients struggling with endometriosis often pursue assisted reproductive technologies (ART) due to fertility issues. The management of ovarian endometrioma, which is a prevalent phenotype, is challenging and controversial, especially in the context of ART.

In the present review, Dr. Garcia-Velasco group from Spain aim to assess the latest findings concerning fertility issues, endometrioma, and assisted reproduction.

Laparoscopic treatment of ovarian endometrioma was first described in 1986. Since then, laparoscopic cystectomy has become the gold standard treatment for ovarian endometrioma with the surgical indication. Surgical excision of ovarian endometrioma affects ovarian reserve, especially in cases of bilateral and recurrent endometriomas. However, surgery performed prior to ART treatment does not always improve reproductive outcomes but rather increases the time to pregnancy and the risks and costs.

Controlled ovarian hyperstimulation (COH) does not affect the quality of life or endometriosis-related pain symptoms. Although some patients may exhibit a diminished ovarian response to COH, their endometrial receptivity, aneuploidy rates, and fertility outcomes are usually similar to healthy controls.

On the other hand, endometrioma, whenever there is a suspicion of malignancy, or when bilateral, along with the presence of clear indication for surgery, the surgical excision along with appropriate histopathological examination are indicated, regardless of the patient age.

In conclusion, "the current evidence does not support the postponement of infertility treatment in favor of surgery, except in cases with severe symptoms or to improve follicle accessibility. In randomized clinical trials, less invasive approaches to ovarian endometrioma treatment must be further evaluated", say researchers.

Research Source: https://www.ncbi.nlm.nih.gov/pubmed/29847457