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Hum. Reprod. Advance Access originally published online on April 26, 2008
Human Reproduction 2008 23(7):1526-1530; doi:10.1093/humrep/den133
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© The Author 2008. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

IVF–ICSI outcome in women operated on for bilateral endometriomas

Edgardo Somigliana1, Mariangela Arnoldi1,2, Laura Benaglia1,2,3, Roberta Iemmello1,2, Anna Elisa Nicolosi1,2 and Guido Ragni1

1 Infertility Unit, Fondazione Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, Via M. Fanti 6, 20122 Milan, Italy 2 Università degli Studi di Milano, Milan, Italy

3 Correspondence address. Tel: +39-02-55034303; Fax: +39-02-55034302. E-mail: laurabenaglia{at}hotmail.it

BACKGROUND: The influence of previous conservative surgery for endometriomas on IVF–ICSI outcome is debated. Conflicting information emerging from the literature may be consequent to the fact that endometriomas are mostly monolateral. The contralateral intact ovary may adequately supply for the reduced function of the affected one. To clarify this point, we assess IVF–ICSI outcome in women operated on for bilateral endometriomas.

METHODS: Women selected for IVF–ICSI cycles who previously underwent bilateral endometriomas cystectomy were matched (1:2) for age and study period with patients who did not undergo prior ovarian surgery.

RESULTS: Sixty-eight cases and 136 controls were recruited. Women operated on for bilateral endometriotic ovarian cysts had a higher withdrawal rate for poor response (P < 0.001). In these patients, despite the use of higher doses of gonadotrophins, the number of follicles (P = 0.006), oocytes retrieved (P = 0.024) and embryos obtained (P = 0.024) were significantly lower. The clinical pregnancy rate per started cycle in cases and controls was 7% and 19% (P = 0.037) and the delivery rate per started cycle was 4% and 17%, respectively (P = 0.013).

CONCLUSIONS: IVF outcome is significantly impaired in women operated on for bilateral ovarian endometriomas.

Key words: cystectomy/endometriosis/endometriomas/IVF/ovarian reserve

Submitted on December 18, 2007; resubmitted on February 11, 2008; accepted on March 28, 2008.


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