Skip to main content

Advertisement

SpringerLink
Log in

Controversies in the management of endometriomas in patients undergoing assisted reproduction

  • Reproductive Medicine
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Introduction

The presence of an endometrioma has been proposed to affect the ovarian function in a negative way. Our aim was to present the key evidence on multiple aspects of endometriomas’ management in subfertile couples scheduled for assisted reproduction technologies (ART).

Materials and Methods

A critical review of the existing literature was performed focusing on the need of endometrioma treatment prior to ART, the relevant options, the potentially participating surgeon’s characteristics and the socioeconomic perspective.

Results

To date, we have no definitive data to suggest whether the damage to the ovaries observed in women with endometriomas may be related to the mere presence of the cyst, the surgical procedure to remove it, the combination of the two, or factors currently unknown. Moreover, there is no conclusive evidence that, for subfertile couples, removal of endometriomas increases the chance of having a baby. The uncertainty regarding the best treatment strategy and factors such as the limited number of tertiary centers for laparoscopic surgery throughout the world seems to further complicate the decision.

Conclusions

Until research addresses the current “grey areas”, the management of endometriomas in patients undergoing ART should be individualized and take into consideration numerous parameters.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Benaglia L, Somigliana E, Vercellini P et al (2009) Endometriotic ovarian cysts negatively affect the rate of spontaneous ovulation. Hum Reprod 24:2183–2186

    Article  PubMed  Google Scholar 

  2. Practice Committee of the American Society for Reproductive Medicine (2006) Endometriosis and infertility. Fertil Steril 86(Suppl 1):S156–S160

    Google Scholar 

  3. Kennedy S, Bergqvist A, Chapron C et al (2005) ESHRE guideline for the diagnosis and treatment of endometriosis. Hum Reprod 20:2698–2704

    Article  PubMed  Google Scholar 

  4. Somigliana E, Vercellini P, Viganό P et al (2006) Should endometriomas be treated before IVF-ICSI cycles? Hum Reprod Update 12:57–64

    Article  PubMed  Google Scholar 

  5. Jacobson TZ, Duffy JM, Barlow D et al (2010) Laparoscopic surgery for subfertility associated with endometriosis. Cochrane Database Syst Rev 1:CD001398

    PubMed  Google Scholar 

  6. Gupta S, Agarwal A, Agarwal R, Loret de Mola JR (2006) Impact of ovarian endometrioma on assisted reproduction outcomes. Reprod Biomed Online 13:349–360

    Article  PubMed  Google Scholar 

  7. Somigliana E, Infantino M, Benedetti F et al (2006) The presence of ovarian endometriomas is associated with a reduced responsiveness to gonadotropins. Fertil Steril 86:192–196

    Article  PubMed  CAS  Google Scholar 

  8. Benaglia L, Pasin R, Somigliana E et al (2011) Unoperated ovarian endometriomas and responsiveness to hyperstimulation. Hum Reprod 26:1356–1361

    Article  PubMed  Google Scholar 

  9. Hughes E, Brown J, Collins JJ et al (2007) Ovulation suppression for endometriosis. Cochrane Database Syst Rev 3:CD000155

    PubMed  Google Scholar 

  10. Benschop L, Farquhar C, van der Poel N, Heineman MJ (2010) Interventions for women with endometrioma prior to assisted reproductive technology. Cochrane Database Syst Rev 11:CD008571

    PubMed  Google Scholar 

  11. Tsoumpou I, Kyrgiou M, Gelbaya TA, Nardo LG (2009) The effect of surgical treatment for endometrioma on in vitro fertilization outcomes: a systematic review and meta-analysis. Fertil Steril 92:75–87

    Article  PubMed  Google Scholar 

  12. Bongioanni F, Revelli A, Gennarelli G et al (2011) Ovarian endometriomas and IVF: a retrospective case-control study. Reprod Biol Endocrinol 9:81

    Article  PubMed  Google Scholar 

  13. Benaglia L, Somigliana E, Vighi V et al (2010) Rate of severe ovarian damage following surgery for endometriomas. Hum Reprod 25:678–682

    Article  PubMed  Google Scholar 

  14. Geber S, Ferreira DP, Spyer Prates LF et al (2002) Effects of previous ovarian surgery for endometriosis on the outcome of assisted reproduction treatment. Reprod Biomed Online 52:162–166

    Article  Google Scholar 

  15. Candiani M, Barbieri M, Bottani B et al (2005) Ovarian recovery after laparoscopic enucleation of ovarian cysts: insights from echographic short-term postsurgical follow-up. J Minim Invasive Gynecol 12:409–414

    Article  PubMed  Google Scholar 

  16. Horikawa T, Nakagawa K, Ohgi S et al (2008) The frequency of ovulation from the affected ovary decreases following laparoscopic cystectomy in infertile women with unilateral endometrioma during a natural cycle. J Assist Reprod Genet 25:239–244

    Article  PubMed  Google Scholar 

  17. Almog B, Sheizaf B, Shalom-Paz E et al (2010) Effects of excision of ovarian endometrioma on the antral follicle count and collected oocytes for in vitro fertilization. Fertil Steril 94:2340–2342

    Article  PubMed  Google Scholar 

  18. Donnez J, Wyns C, Nisolle M (2001) Does ovarian surgery for endometriomas impair the ovarian response to gonadotropin? Fertil Steril 76:662–665

    Article  PubMed  CAS  Google Scholar 

  19. Alborzi S, Ravanbakhsh R, Parsanezhad ME et al (2007) A comparison of follicular response of ovaries to ovulation induction after laparoscopic ovarian cystectomy or fenestration and coagulation versus normal ovaries in patients with endometrioma. Fertil Steril 88:507–509

    Article  PubMed  Google Scholar 

  20. Ercan CM, Sakinci M, Duru NK et al (2010) Antimullerian hormone levels after laparoscopic endometrioma stripping surgery. Gynecol Endocrinol 26:468–472

    Article  PubMed  CAS  Google Scholar 

  21. Roman H, Tarta O, Pura I et al (2010) Direct proportional relationship between endometrioma size and ovarian parenchyma inadvertently removed during cystectomy, and its implication on the management of enlarged endometriomas. Hum Reprod 25:1428–1432

    Article  PubMed  Google Scholar 

  22. Fernando S, Breheny S, Jaques AM et al (2009) Preterm birth, ovarian endometriomata, and assisted reproductive technologies. Fertil Steril 91:325–330

    Article  PubMed  Google Scholar 

  23. Benaglia L, Somigliana E, Vighi V et al (2009) Is the dimension of ovarian endometriomas significantly modified by IVF-ICSI cycles? Reprod Biomed Online 18:401–406

    Article  PubMed  Google Scholar 

  24. Benaglia L, Somigliana E, Santi G et al (2011) IVF and endometriosis-related symptom progression: insights from a prospective study. Hum Reprod 26:2368–2372

    Article  PubMed  Google Scholar 

  25. Matsunaga Y, Fukushima K, Nozaki M et al (2003) A case of pregnancy complicated by the development of a tubo-ovarian abscess following in vitro fertilization and embryo transfer. Am J Perinatol 20:277–282

    Article  PubMed  Google Scholar 

  26. Kelada E, Ghani R (2007) Bilateral ovarian abscesses following transvaginal oocyte retrieval for IVF: a case report and review of literature. J Assist Reprod Genet 24:143–145

    Article  PubMed  Google Scholar 

  27. Benaglia L, Somigliana E, Iemmello R et al (2008) Endometrioma and oocyte retrieval-induced pelvic abscess: a clinical concern or an exceptional complication? Fertil Steril 89:1263–1266

    Article  PubMed  Google Scholar 

  28. Somigliana E, Viganό P, Parazzini F et al (2006) Association between endometriosis and cancer: a comprehensive review and critical analysis of clinical and epidemiological evidence. Gynecol Oncol 101:331–341

    Article  PubMed  Google Scholar 

  29. Somigliana E, Vercellini P, Vigano P et al (2010) Non-invasive diagnosis of endometriosis: the goal or own goal? Hum Reprod 25:1863–1868

    Article  PubMed  Google Scholar 

  30. Somigliana E, Arnoldi M, Benaglia L et al (2008) IVF-ICSI outcome in women operated on for bilateral endometriomas. Hum Reprod 23:1526–1530

    Article  PubMed  Google Scholar 

  31. Demirol A, Guven S, Baykal C, Gurgan T (2006) Effect of endometrioma cystectomy on IVF outcome: a prospective randomized study. Reprod Biomed Online 12:639–643

    Article  PubMed  Google Scholar 

  32. de Ziegler D, Borghese B, Chapron C (2010) Endometriosis and infertility: pathophysiology and management. Lancet 376:730–738

    Article  PubMed  Google Scholar 

  33. Farquhar C, Sutton C (1998) The evidence for the management of endometriosis. Curr Opin Obstet Gynecol 104:321–332

    Article  Google Scholar 

  34. Sallam HN, Garcia-Velasco JA, Dias S et al (2006) Long-term pituitary down-regulation before in vitro fertilization (IVF) for women with endometriosis. Cochrane Database Syst Rev 1:CD004635

    PubMed  Google Scholar 

  35. Canis M, Mage G, Wattiez A et al (2003) The ovarian endometrioma: why is it so poorly managed? Laparoscopic treatment of large ovarian endometrioma: why such a long learning curve? Hum Reprod 18:5–7

    Article  PubMed  CAS  Google Scholar 

  36. Lalchandani S, Baxter A, Phillips K (2005) Is helium thermal coagulator therapy for the treatment of women with minimal to moderate endometriosis cost-effective? A prospective randomised controlled trial. Gynecol Surg 2:255–258

    Article  Google Scholar 

  37. Medeiros LR, Rosa DD, Bozzetti MC et al (2009) Laparoscopy versus laparotomy for benign ovarian tumour. Cochrane Database Syst Rev 2:CD004751

    PubMed  Google Scholar 

  38. Moayeri SE, Lee HC, Lathi RB et al (2009) Laparoscopy in women with unexplained infertility: a cost-effectiveness analysis. Fertil Steril 92:471–480

    Article  PubMed  Google Scholar 

  39. Hart RJ, Hickey M, Maouris P, Buckett W (2008) Excisional surgery versus ablative surgery for ovarian endometriomata. Cochrane Database Syst Rev 2:CD004992

    PubMed  Google Scholar 

  40. Maheshwari A, Gibreel A, Bhattacharya S, Johnson NP (2009) Dynamic tests of ovarian reserve: a systematic review of diagnostic accuracy. Reprod Biomed Online 18:717–734

    Article  PubMed  Google Scholar 

  41. Tsolakidis D, Pados G, Vavilis D et al (2010) The impact on ovarian reserve after laparoscopic ovarian cystectomy versus three-stage management in patients with endometriomas: a prospective randomized study. Fertil Steril 94:71–77

    Article  PubMed  CAS  Google Scholar 

  42. Pados G, Tsolakidis D, Assimakopoulos E et al (2010) Sonographic changes after laparoscopic cystectomy compared with three-stage management in patients with ovarian endometriomas: a prospective randomized study. Hum Reprod 25:672–677

    Article  PubMed  Google Scholar 

  43. Muzii L, Bellati F, Palaia I et al (2005) Laparoscopic stripping of endometriomas: a randomized trial on different surgical techniques. Part I: clinical results. Hum Reprod 20:1981–1986

    Article  PubMed  Google Scholar 

  44. Muzii L, Bellati F, Bianchi A et al (2005) Laparoscopic stripping of endometriomas: a randomized trial on different surgical techniques. Part II: pathological results. Hum Reprod 20:1987–1992

    Article  PubMed  Google Scholar 

  45. Mossa B, Ebano V, Tucci S et al (2010) Laparoscopic surgery for the management of ovarian endometriomas. Med Sci Monit 16:MT45–MT50

    PubMed  Google Scholar 

  46. Saeki A, Matsumoto T, Ikuma K et al (2010) The vasopressin injection technique for laparoscopic excision of ovarian endometrioma: a technique to reduce the use of coagulation. J Minim Invasive Gynecol 17:176–179

    Article  PubMed  Google Scholar 

  47. Vercellini P, Somigliana E, Vigano P et al (2009) Surgery for endometriosis-associated infertility: a pragmatic approach. Hum Reprod 24:254–269

    Article  PubMed  Google Scholar 

  48. Yu HT, Huang HY, Soong YK et al (2010) Laparoscopic ovarian cystectomy for endometriomas: surgeons’ experience may affect ovarian reserve and live-born rate in infertile patients with in vitro fertilization-intracytoplasmic sperm injection. Eur J Obstet Gynecol Reprod Biol 152:172–175

    Article  PubMed  Google Scholar 

  49. Canis M, Pouly JL, Tamburro S et al (2001) Ovarian response during IVF-embryo transfer cycles after laparoscopic ovarian cystectomy for endometriotic cysts of >3 cm in diameter. Hum Reprod 16:2583–2586

    Article  PubMed  CAS  Google Scholar 

  50. Donnez J, Lousse JC, Jadoul P et al (2010) Laparoscopic management of endometriomas using a combined technique (cystectomy) and ablative surgery. Fertil Steril 94:28–32

    Article  PubMed  Google Scholar 

  51. Moses SH, Clark JT (2004) Current practice for the laparoscopic diagnosis and treatment of endometriosis: a national questionnaire survey of consultant gynaecologists in UK. BJOG 111:1269–1272

    Article  PubMed  Google Scholar 

  52. Jones KD, Fan A, Sutton CJ (2002) The ovarian endometrioma: why is it so poorly managed? Indicators from an anonymous survey. Hum Reprod 17:845–849

    Article  PubMed  CAS  Google Scholar 

  53. Ball E, Koh C, Janik G, Davis C (2008) Gynaecological laparoscopy: ‘see and treat’ should be the gold standard. Curr Opin Obstet Gynecol 20:325–330

    Article  PubMed  Google Scholar 

  54. Balasch J (2010) Ageing and infertility: an overview. Gynecol Endocrinol 26:855–860

    Article  PubMed  Google Scholar 

  55. Al-Azemi M, Bernal AL, Steele J et al (2000) Ovarian response to repeated controlled stimulation in in-vitro fertilization cycles in patients with ovarian endometriosis. Hum Reprod 15:72–75

    Article  PubMed  CAS  Google Scholar 

  56. Oddens BJ, den Tonkelaar I, Nieuwenhuyse H (1999) Psychosocial experiences in women facing fertility problems-a comparative study. Hum Reprod 14:255–261

    Article  PubMed  CAS  Google Scholar 

  57. Matsubayashi H, Hosaka T, Izumi S et al (2001) Emotional distress of infertile women in Japan. Hum Reprod 16:966–969

    Article  PubMed  CAS  Google Scholar 

  58. Dyer SJ, Abrahams N, Hoffman M, van der Spuy ZM (2002) ‘Men leave me as I cannot have children’: women’s experiences with involuntary childlessness. Hum Reprod 17:1663–1668

    Article  PubMed  CAS  Google Scholar 

  59. Zhao SZ, Wong JM, Davis MB et al (1998) The cost of inpatient endometriosis treatment: an analysis based on the Healthcare Cost and Utilization Project Nationwide Inpatient Sample. Am J Manag Care 4:1127–1134

    PubMed  CAS  Google Scholar 

  60. Gao X, Outley J, Botteman M et al (2006) Economic burden of endometriosis. Fertil Steril 86:1561–1572

    Article  PubMed  Google Scholar 

  61. Simoens S, Hummelshoj L, Dunselman G et al (2011) Endometriosis cost assessment (the EndoCost study): a cost-of-illness study protocol. Gynecol Obstet Invest 71:170–176

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The authors would like to thank Elena Gagari, DMD, DMSc (Assistant Professor of Mucosal Diseases-Dermatology, University of Athens, School of Medicine) for all her advice on the English grammar and syntax of the manuscript.

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Assisted Reproduction Unit, 3rd Department of Obstetrics and Gynecology, University of Athens, Attikon Hospital, 1 Rimini Street, Chaidari, 12462, Athens, Greece

    Charalampos Siristatidis, Charalampos Chrelias, Vasileios D. Sioulas, Vasiliki A. Stathopoulou, George-Marios C. Makris, George Koliopoulos & Dimitrios Kassanos

Authors
  1. Charalampos Siristatidis
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Charalampos Chrelias
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Vasileios D. Sioulas
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Vasiliki A. Stathopoulou
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. George-Marios C. Makris
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. George Koliopoulos
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Dimitrios Kassanos
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Vasileios D. Sioulas.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Siristatidis, C., Chrelias, C., Sioulas, V.D. et al. Controversies in the management of endometriomas in patients undergoing assisted reproduction. Arch Gynecol Obstet 286, 1563–1569 (2012). https://doi.org/10.1007/s00404-012-2538-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00404-012-2538-5

Keywords

Search

Navigation