Fertility Outcome after CO2 Laser Vaporization versus Cystectomy in Women with Ovarian Endometrioma: A Comparative Study

Massimo Candiani, Stefano Ferrari, Ludovica Bartiromo, Matteo Schimberni, Iacopo Tandoi, and Jessica Ottolina

Journal of Minimally Invasive Gynecology. (May 2020)

Study Objective
: To assess the postoperative likelihood of conception in patients with endometriomas managed by either CO2 laser vaporization or cystectomy.
Design: A retrospective study with prospective recording of data.
Setting: University hospital.
Patients: One hundred and forty-two patients with symptomatic endometriomas.
Interventions: Patients underwent a standardized laparoscopic stripping technique (Group 1) or cyst vaporization with CO2 fiber laser (Group 2). Patients wishing to become pregnant were allowed to attempt a spontaneous conception after surgery. If spontaneous conception failed, patients were referred for in vitro fertilization (IVF).
Measurements and Main Results: The primary objective was to compare pregnancy rates between the 2 groups. The sec-ondary objective was the identification of independent predictors of pregnancy. Thirty-nine women in Group 1 (53.4%) and 39 women in Group 2 (56.5%) desired to conceive after surgery. Three patients (7.7%) in Group 1 became pregnant follow-ing donor-IVF and were excluded. Pregnancies were recorded in 72.2% of patients treated with cystectomy and in 74.3% of those managed with CO2 fiber laser (p = .83). Twenty patients (55.6%) in Group 1 and 14 patients (35.9%) in Group 2 con-ceived spontaneously (p = .08). Among patients who failed spontaneous conception, 21 patients (28%) achieved pregnancy through IVF (Group 1: n = 6, 16.7%; Group 2: n = 15, 38.5%; p = .08). Twenty patients (26.7%) never became pregnant. Age at the time of surgery (odds ratio (OR) = 0.86; 95% Confidence intervals (CI): 0.78−0.96, p = .002) and duration of infertility (OR=0.80; 95% CI: 0.69−0.92, p = .006) were identified as independent indicators for pregnancy.
Conclusion: CO2 laser-treated endometrioma is associated with pregnancy rates equal to those observed after cystectomy and favorable IVF outcomes. The one step CO2 fiber laser technique may represent a viable alternative to cystectomy. Jour-nal of Minimally Invasive Gynecology (2020) 00, 1−8. © 2020 AAGL. All rights reserved.
Keywords: Carbon dioxide fiber laser; Ovarian endometriosis; Reproductive surgery; Pregnancy rate


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