NEWS: New Study Demonstrates that Ovarian Endometriomas Do Not Affect Ooctye Quality in IVF Cycles

Literature search reveals contradictory findings on the effect of ovarian endometriomas on IVF outcomes. Now, a recent prospective study, published in Fertility and Sterility, provides further insight and hope to patients with ovarian endometriomas by indicating the absence of any detrimental effect on oocyte developmental competence.

Francesca Filippi and coworkers from the Department of Obstetrics and Gynecology, Fondazione Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy, prospectively assessed 29 women with unilateral endometrioma, which was unoperated, to investigate its impact on ovarian function in IVF cycles. A comparison between the endometrioma-affected and contralateral normal gonads was performed to determine the oocyte quality and ovarian responsiveness. The results showed that there was no statistically significant difference between the intact and affected gonads with respect to both these parameters. The other parameters are listed in Table 1.

Table 1: Comparison of Ovarian function and IVF outcomes between Intact Gonads and
Endometrioma-affected ovary

Parameters Intact Gonads Endometrioma-affected gonads
Number of codominant follicles 4.1±1.7 3.7±2.4
Number of suitable oocytes 3.5±2.3 3.1±2.6
Number of oocytes retrieved 4.7±2.5 4.2±3.1
Number of viable embryos 1.8 ± 1.4 1.8 ± 2.1
Number of high-quality embryos 0.8±0.7 1.0±1.7
Fertilization rate 64% 64%
Cleavage rate 51% 58%
Rate of high-quality embryos 21% 31%



Based on the findings, the researchers concluded that the presence of an ovarian endometrioma may not negatively impact the ovarian function and oocyte quality.

Similar findings were reported in an earlier retrospective multicenter cohort study by Benaglia et al (Fertility and Sterility, 2011), wherein bilateral endometriomas were not found to adversely affect oocyte quality and chances of pregnancy in IVF cycles. Analyzing 39 women having bilateral endometriomas and 78 controls, the researchers observed no difference between the two groups with respect to the average rates of top-quality embryos per oocyte (33% in both), implantation rates (22% and 23%, respectively), clinical pregnancy rate, and delivery rate. The corresponding numbers of oocytes retrieved were 7.1±3.2 and 9.8±5.5, and oocyte retrieval rate per total number of developing follicles were 77% and 71%. However, it was found that the presence of endometriomas hampered ovarian responsiveness to hyperstimulation.

There has been an extensive debate over the years on the unproven, classic dogma that excision of endometrioma should be performed in all infertile women before undergoing IVF. Several studies have been conducted to verify if the surgery of endometrioma before IVF cycles improves the treatment outcomes. In one such retrospective, matched case-control study on 189 women with endometriomas, Garcia-Velasco et al (Fertility and Sterility, 2004) observed that fertility outcomes are not improved by laparoscopic cystectomy of endometriomas. The scientists suggested that women with asymptomatic endometrioma should be directly offered controlled ovarian hyperstimulation as it may aid in reducing treatment cost, time-to-pregnancy, and probable laparoscopic surgery complications. They also indicated that surgery in women with symptomatic endometrioma may not hamper IVF success rates.

Research indicates the lack of adequate knowledge to clearly understand how ovarian endometrioma may lead to infertility and related complications like decreased oocyte quantity and quality. Considering this, a review by Carnahan et al (Expert Review of Obstetrics Gynecology, 2013) emphasized the importance of better understanding the disease and its impact on fertility outcomes in order to improve the IVF protocols, surgical treatments, and fertility preservation techniques. The expert commentary also opined that it is crucial to report all pregnancy rates (through both natural conception and assisted reproduction) in such women to develop new and better treatment options, apart from helping to ascertain the most beneficial treatment in patients with ovarian endometriomas.

References

  • Filippi F, Benaglia L, Paffoni A, et al. Ovarian endometriomas and oocyte quality: insights from in vitro fertilization cycles. Fertil Steril. 2014 Apr;101(4):988-993.e1. doi: 10.1016/j.fertnstert.2014.01.008.
  • Benaglia L, Bermejo A, Somigliana E, et al. In vitro fertilization outcome in women with unoperated bilateral endometriomas. Fertil Steril. 2013 May;99(6):1714-9. doi: 10.1016/j.fertnstert.2013.01.110.
  • Garcia-Velasco JA, Mahutte NG, Corona J, et al. Removal of endometriomas before in vitro fertilization does not improve fertility outcomes: a matched, case-control study. Fertil Steril. 2004 May;81(5):1194-7.
  • Carnahan M, Fedor J, Agarwal A, Gupta S. Ovarian endometrioma: guidelines for selection of cases for surgical treatment or expectant management. Expert Rev Obstet Gynecol. 2013;8(1):29-55.

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