Archives of Gynecology and Obstetrics (2018) 297:1043–1057
GYNECOLOGIC ENDOCRINOLOGY AND REPRODUCTIVE MEDICINE
The eect of surgical management of endometrioma on the IVF/ICSI
outcomes when compared with no treatment? A systematic review
· R. Savant
· K. Majumder
· E. Edi‑O’sagie
· M. Akhtar
Received: 13 June 2017 / Accepted: 22 December 2017 / Published online: 17 January 2018
© The Author(s) 2018. This article is an open access publication
Objective To assess the impact of surgical management of endometrioma on the outcome of assisted reproduction treatment
Design A systematic review and meta-analysis.
Setting Department of reproductive medicine at teaching university hospital, UK.
Patients Subfertile women with endometrioma undergoing ART.
Interventions Surgical removal of endometrioma or expectant management.
Main outcome measures Clinical pregnancy rate, pregnancy rate, live birth rate, number of oocytes retrieved and number
of embryos available and ovarian response to gonadotrophins.
Results An extensive search of electronic databases for articles published from inception to September 2016 yielded 11
eligible studies for meta-analysis. Meta-analysis was conducted comparing surgery versus no treatment of endometrioma.
There were no signiﬁcant diﬀerences in pregnancy rate per cycle, clinical pregnancy rate and live birth rate between women
who underwent surgery for endometrioma and those who did not.
Conclusion Current evidence suggests that women with endometriosis-related infertility have similar cycle outcomes to
other patients going through ART. It is pertinent for clinicians to assess the risks of surgical intervention on ovarian reserve
prior to initiating therapy.
Keywords Endometrioma · Surgery · ART · Pregnancy outcome
Endometriosis is a chronic-debilitating disease that aﬀects
5–10% of fertile women . It is characterised by the pres-
ence of endometrial-like tissue (glands and stroma) outside
the uterus, which induces a chronic inﬂammatory reaction,
scar tissue, and adhesions that may distort a woman’s pelvic
anatomy . Around 25–50% of women with infertility may
be aﬀected by endometriosis, and 30–50% of women with
endometriosis have infertility .
Women with endometriosis often require assisted repro-
duction technology (ART) and the severity of endometrio-
sis has been linked to ART outcome . However, further
research is necessary to understand this association. Multiple
hypotheses have been suggested to explain the low fecundity
observed with endometriosis. Most commonly, the associa-
tion has been attributed to altered folliculogenesis resulting
in reduced quality oocytes , mechanical interference with
oocyte pickup and transportation , exposure to a hostile
environment of macrophages, cytokines and vasoactive sub-
stances in the peritoneal ﬂuid [7, 8] and anatomical dysfunc-
tion of the fallopian tube and ovary .
An endometrioma is the formation of a cyst within the
ovary with ectopic endometrial tissue lining [10, 11]. An
endometrioma is one of the most common manifestations
of endometriosis. Endometriomas are found in 17–44% of
patients with endometriosis . The pathogenesis of an
endometrioma is complex and diﬀerent compared to that of
* M. Nickkho-Amiry
University Hospital of South Manchester, Southmoor Rd,
Wythenshawe, Manchester M23 9LT, UK
Central Manchester Foundation Trust, Manchester, UK