Removal of endometriomas before in vitro fertilization does not improve fertility outcomes:: a matched, case-control study

Objective: To investigate whether conservative surgery on ovarian endometriomas before an IVF cycle improves fertility outcomes. Design: Retrospective, matched case-control study. Setting: Two academic IVF programs. Patient(s): One hundred eighty-nine women with endometriomas who underwent IVF treatment: 56 women proceeded directly to IVF, and 133 first underwent conservative ovarian surgery. Intervention(s): Controlled ovarian hyperstimulation and IVF-ET. Main Outcome Measure(s): Response to gonadotropins, fertilization, implantation, and pregnancy rates. Result(s): Aside from lower peak E-2 levels on the day of hCG and a higher total FSH dose in women previously operated for an endometrioma, no significant differences were found between the two groups in the different IVF variables analyzed. Conclusion(s): Laparoscopic cystectomy for endometriomas before commencing an IVF cycle does not improve fertility outcomes. Proceeding directly to controlled ovarian hyperstimulation in women with asymptomatic ovarian endometriomas might reduce the time to pregnancy, the costs of treatment, and the hypothetical complications of laparoscopic surgery. Conversely, conservative surgical treatment of ovarian endometriomas in symptomatic women does not impair IVF or intracytoplasmic sperm injection success rates. (Fertil Steril(R) 2004;81:1194-7. (C) 2004 by American Society for Reproductive Medicine.).