Skip to main content
Log in

Laparoscopic excision of ovarian endometrioma does not exert a qualitative effect on ovarian function: insights from in vitro fertilization and single embryo transfer cycles

  • Assisted Reproduction Technologies
  • Published:
Journal of Assisted Reproduction and Genetics Aims and scope Submit manuscript

Abstract

Purpose

To evaluate whether laparoscopic excision of endometrioma exerts a qualitative effect on ovarian function.

Methods

A retrospective analysis of oocytes retrieved in 25 cycles of 21 patients undergoing IVF treatment with controlled ovarian stimulation. The number of oocytes recovered from ovaries with a history of excision of endometrioma (E-Ov) were compared to those from contra-lateral healthy ovaries (H-Ov) as for the analysis of a quantitative effect of surgery. As for the analysis of a qualitative effect, 55 oocytes from E-Ov were compared to 128 oocytes from H-Ov in terms of normal fertilization rate and the rate of top-quality embryos per normally fertilized eggs. Furthermore, 10 embryos derived from oocytes recovered from E-Ov were compared to 24 embryos derived from oocytes from H-Ov in terms of clinical and on-going pregnancy rates per embryos in 34 single embryo transfer cycles.

Results

Mean number of oocytes recovered from E-Ov was significantly smaller than that from H-Ov (2.2 ± 2.0 vs. 5.1 ± 3.3, P = 0.009). There was no difference between oocytes from E-Ov and H-Ov as for normal fertilization rate (63.6 % vs. 69.5 %, P = 0.43) and the rate of top-quality embryos (40.0 % vs. 49.0 %, P = 0.34). Clinical and on-going pregnancy rates per embryos were also similar in embryos derived from oocytes recovered from E-Ov and H-Ov (40.0 % vs. 25.0 %, P = 0.39 and 20.0 % vs. 20.8 %, P = 0.96).

Conclusions

The quality of oocytes recovered from the ovary with a history of laparoscopic excision of endometrioma is not inferior to the quality of oocytes from contra-lateral healthy ovary.

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

Access this article

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

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Eskenazi B, Warner ML. Epidemiology of endometriosis. Obstet Gynecol Clin N Am. 1997;24:235–58.

    Article  CAS  Google Scholar 

  2. Giudice LC. Clinical practice. Endometriosis N Engl J Med. 2010;362:2389–98.

    Article  CAS  Google Scholar 

  3. Vercellini P, Chapron C, De Giorgi O, Consonni D, Frontino G, Crosignani PG. Coagulation or excision of ovarian endometriomas? Am J Obstet Gynecol. 2003;188:606–10.

    Article  PubMed  Google Scholar 

  4. Gupta S, Goldberg JM, Aziz N, Goldberg E, Krajcir N, Agarwal A. Pathogenic mechanisms in endometriosis-associated infertility. Fertil Steril. 2008;90:247–57.

    Article  CAS  PubMed  Google Scholar 

  5. Bulleti C, Coccia ME, Battistoni S, Borini A. Endometriosis and infertility. J Assist Reprod Genet. 2010;27:441–7.

    Article  Google Scholar 

  6. Norenstedt SN, Linderoth-Nagy C, Bergendal A, Sjöblom P, Bergqvist A. Reduced developmental potential in oocytes from women with endometriosis. J Assist Reprod Genet. 2001;18:644–9.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  7. Allegra A, Raimondo S, Volpes A, Fenale D, Marino A, Cicero G, et al. The gene expression profile of cumulus cells reveals altered pathways in patients with endometriosis. J Assist Reprod Genet. 2014;31:1277–85.

    Article  PubMed  Google Scholar 

  8. La Marca A, Sighinolfi G, Radi D, Argento C, Baraldi E, Artenisio AC, et al. Anti-Mullerian hormone (AMH) as a predictive marker in assisted reproductive technology (ART). Hum Reprod Update. 2010;16:113–30.

    Article  PubMed  Google Scholar 

  9. Somigliana E, Ragni G, Infantino M, Benedetti F, Arnoldi M, Crosignani PG. Does laparoscopic removal of nonendometriotic benign ovarian cysts affect ovarian reserve? Acta Obstet Gynecol Scand. 2006;85:74–7.

    Article  PubMed  Google Scholar 

  10. Raffi F, Metwally M, Amer S. The impact of excision of ovarian endometrioma on ovarian reserve: a systematic review and meta-analysis. J Clin Endocrinol Metab. 2012;97:3146–54.

    Article  CAS  PubMed  Google Scholar 

  11. Rustamov O, Smith A, Roberts SA, Yates AP, Fitzgerald C, Krishnan M, et al. Anti-Mullerian hormone: poor assay reproducibility in a large cohort of subjects suggests sample instability. Hum Reprod. 2012;27:3085–91.

    Article  CAS  PubMed  Google Scholar 

  12. Ledger WL. Measurement of antimullerian hormone: not as straightforward as it seems. Fertil Steril. 2014;101:339.

    Article  PubMed  Google Scholar 

  13. Lass A. The fertility potential of women with a single ovary. Hum Reprod Update. 1999;5:546–50.

    Article  CAS  PubMed  Google Scholar 

  14. Loh FH, Tan AT, Kumar J, Ng SC. Ovarian response after laparoscopic ovarian cystectomy for endometriotic cysts in 132 monitored cycles. Fertil Steril. 1999;72:316–21.

    Article  CAS  PubMed  Google Scholar 

  15. Ho HY, Lee RK, Hwu YM, Lin MH, Su JT, Tsai YC. Poor response of ovaries with endometrioma previously treated with cystectomy to controlled ovarian hyperstimulation. J Assist Reprod Genet. 2002;19:507–11.

    Article  PubMed Central  PubMed  Google Scholar 

  16. Somigliana E, Ragni G, Benedetti F, Borroni R, Vegetti W, Crosignani PG. Does laparoscopic excision of endometriotic ovarian cysts significantly affect ovarian reserve? Insights from IVF cycles. Hum Reprod. 2003;18:2450–3.

    Article  CAS  PubMed  Google Scholar 

  17. Ragni G, Somigliana E, Benedetti F, Paffoni A, Vegetti W, Restelli L, et al. Damage to ovarian reserve associated with laparoscopic excision of endometriomas: a quantitative rather than a qualitative injury. Am J Obstet Gynecol. 2005;193:1908–14.

    Article  PubMed  Google Scholar 

  18. Duru NK, Dede M, Acikel CH, Keskin U, Fidan U, Baser I. Outcome of in vitro fertilization and ovarian response after endometrioma stripping at laparoscopy and laparotomy. J Reprod Med. 2007;52:805–9.

    PubMed  Google Scholar 

  19. Almog B, Sheizaf B, Shalom-Paz E, Shehata F, Al-Talib A, Tulandi T. Effects of excision of ovarian endometrioma on the antral follicle count and collected oocytes for in vitro fertilization. Fertil Steril. 2010;94:2340–2.

    Article  PubMed  Google Scholar 

  20. Veeck LL. Preembryo grading and degree of cytoplasmic fragmentation. An atlas of human gametes and conceptuses: an illustrated reference for assisted reproductive technology. NewYork: Parthenon Publishing; 1999. p. 46–51.

    Book  Google Scholar 

  21. Gardner DK, Schoolcraft WB. In vitro culture of human blastocysts. In: Jansen R, Mortimer D, editors. Toward reproductive certainty: fertility and genetics beyond. London: Parthenon Publishing; 1999. p. 378–88.

    Google Scholar 

  22. Alborzi S, Foroughinia L, Kumar PV, Asadi N, Alborzi S. A comparison of histopathologic findings of ovarian tissue inadvertently excised with endometrioma and other kinds of benign ovarian cyst in patients undergoing laparoscopy versus laparotomy. Fertil Steril. 2009;92:2004–7.

    Article  PubMed  Google Scholar 

  23. Muzii L, Bianchi A, Croce C, Manci N, Panici PB. Laparoscopic excision of ovarian cysts: is the stripping technique a tissue-sparing procedure? Fertil Steril. 2002;77:609–14.

    Article  PubMed  Google Scholar 

  24. La Torre R, Montanino-Oliva M, Marchiani E, Boninfante M, Montanino G, Cosmi EV. Ovarian blood flow before and after conservative laparoscopic treatment for endometrioma. Clin Exp Obstet Gynecol. 1998;25:12–4.

    PubMed  Google Scholar 

  25. Wu MH, Tsai SJ, Pan HA, Hsiao KY, Chang FM. Three-dimensional power Doppler imaging of ovarian stromal blood flow in women with endometriosis undergoing in vitro fertilization. Ultrasound Obstet Gynecol. 2003;21:480–5.

    Article  PubMed  Google Scholar 

  26. Bhal PS, Pugh ND, Chui DK, Gregory L, Walker SM, Shaw RW. The use of transvaginal power Doppler ultrasonography to evaluate the relationship between perifollicular vascularity and outcome in in-vitro fertilization treatment cycles. Hum Reprod. 1999;14:939–45.

    Article  CAS  PubMed  Google Scholar 

  27. Borini A, Tallarini A, Maccolini A, Prato LD, Flamigni C. Perifollicular vascularity monitoring and scoring: a clinical tool for selecting the best oocyte. Eur J Obstet Gynecol Reprod Biol. 2004;115 Suppl 1:S102–5.

    Article  PubMed  Google Scholar 

  28. Sugita A, Iwase A, Goto M, Nakahara T, Nakamura T, Kondo M, et al. One-year follow-up of serum antimullerian hormone levels in patients with cystectomy: are different sequential changes due to different mechanisms causing damage to the ovarian reserve? Fertil Steril. 2013;100:516–22.

    Article  CAS  PubMed  Google Scholar 

  29. Biacchiardi CP, Piane LD, Camanni M, Deltetto F, Delpiano EM, Marchino GL, et al. Laparoscopic stripping of endometriomas negatively affects ovarian follicular reserve even if performed by experienced surgeons. Reprod BioMed Online. 2011;23:740–6.

    Article  PubMed  Google Scholar 

  30. Celik HG, Dogan E, Okyay E, Ulukus C, Saatli B, Uysal S, et al. Effect of laparoscopic excision of endometriomas on ovarian reserve: serial changes in the serum antimullerian hormone levels. Fertil Steril. 2012;97:1472–8.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

Authors thank to patients and staff, especially Ms. Nagisa Oi, at the IVF center in University of Tokyo Hospital. Authors also thank to Dr. Akihisa Fujimoto, Dr. Hajime Oishi, Dr. Masashi Takamura, and Dr. Gentaro Izumi for their valuable comments.

Compliance with ethical standards

Funding

This work was supported by Grant-in-Aids for Scientific Research from Japan Society for the Promotion of Science.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Miyuki Harada.

Additional information

Capsule The quality of oocytes recovered from the ovary with a history of laparoscopic excision of endometrioma is not inferior to the quality of oocytes from contra-lateral healthy ovary.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Harada, M., Takahashi, N., Hirata, T. et al. Laparoscopic excision of ovarian endometrioma does not exert a qualitative effect on ovarian function: insights from in vitro fertilization and single embryo transfer cycles. J Assist Reprod Genet 32, 685–689 (2015). https://doi.org/10.1007/s10815-015-0457-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10815-015-0457-7

Keywords

Navigation