The impact of endometrioma on IVF/ICSI outcomes: a systematic review and meta-analysis

M. Hamdan, G. Dunselman, T.C. Li, Y. Cheong

Human Reproduction Update, Vol.0, No.0 pp. 1–17, 2015

Background: Endometriosis is a disease known to be detrimental to fertility. Women with endometriosis, and the presence of endome-trioma, may require artificial reproductive techniques (ART) to achieve a pregnancy. The specific impact of endometrioma alone and the impact of surgical intervention for endometrioma on the reproductive outcome of women undergoing IVF/ICSI are areas that require further clarification. The objectives of this review were as follows: (i) to determine the impact of endometrioma on IVF/ICSI outcomes, (ii) to determine the impact of surgery for endometrioma on IVF/ICSI outcome and (iii) to determine the effect of different surgical techniques on IVF/ICSI outcomes.
methods: We performed a systematic review and meta-analysis examining subfertile women who have endometrioma and are undergoing IVF/ICSI, and who have or have not had any surgical management for endometrioma before IVF/ICSI. The primary outcome was live birth rate (LBR). Our secondary outcomes were clinical pregnancy rate (CPR), mean number of oocyte retrieved (MNOR), miscarriage rate (MR), fertil-ization rate, implantation rate, antral follicle count (AFC), total stimulating hormone dose, and any rates of adverse effects such as cancellation and associated complications during the IVF/ICSI treatment.
results: We included 33 studies for the meta-analysis. The majority of the studies were retrospective (30/33), and three were RCTs. Com-pared with women with no endometrioma undergoing IVF/ICSI, women with endometrioma had a similar LBR (odds ratio [OR] 0.98; 95% CI
[0.71, 1.36], 5 studies, 928 women, I2 ¼ 0%) and a similar CPR (OR 1.17; 95% CI [0.87, 1.58], 5 studies, 928 women, I2 ¼ 0%), a lower mean number of oocytes retrieved (SMD 20.23; 95% CI [20.37, 20.10], 5 studies, 941 cycles, I22¼ 37%) and a higher cycle cancellation rate com-
pared with those without the disease (OR 2.83; 95% CI [1.32, 6.06], 3 studies, 491 women, I ¼ 0%). Compared with women with no surgical treatment, women who had their endometrioma surgically treated before IVF/ICSI had a similar LBR (OR 0.90; 95% CI [0.63, 1.28], 5 studies, 655
women, I2 ¼ 32%), a similar CPR (OR 0.97; 95% CI [0.78, 1.20], 112studies, 1512 women, I2 ¼ 0%) and a similar mean number of oocytes
retrieved (SMD 20.17; 95% CI [20.38, 0.05], 9 studies, 810 cycles, I ¼ 63%).
conclusions: Women with endometrioma undergoing IVF/ICSI had similar reproductive outcomes compared with those without the
disease, although their cycle cancellation rate was significantly higher. Surgical treatment of endometrioma did not alter the outcome of IVF/ICSI treatment compared with those who did not receive surgical intervention. Considering that the reduced ovarian reserve may be attrib-
uted to the presence of endometrioma per se,and thepotential detrimentalimpact fromsurgical intervention, individualizationof care forwomen
with endometrioma prior to IVF/ICSI may help optimize their IVF/ICSI results.

Key words: endometriosis / IVF/ICSI / surgery / pregnancy / endometrioma


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