Surgery prior to assisted reproductive technology for women with endometrioma

Surgery prior to assisted reproductive technology might possibly not be effective for increasing pregnancy rates in women with endometrioma, but the evidence is insufficient.

Comment: The quality of evidence is downgraded by study limitations (selective reporting and lack of blinding and).

Summary

A Cochrane review included 4 studies with a total of 312 subjects. In two trials, surgery (aspiration or cystectomy) versus expectant management (EM) showed no evidence of a benefit for clinical pregnancy with either technique. Aspiration was associated with greater number of mature oocytes retrieved (NMOR) (MD 0.50, 95% CI 0.02 to 0.98) and increased ovarian response (E2 levels on day of hCG injection) (MD 685.3, 95% CI 464.50 to 906.10) compared to EM. Cystectomy was associated with a decreased ovarian response to controlled ovarian hyperstimulation (MD -510.00, 95% CI -676.62 to -343.38); no evidence of an effect on the NMOR compared to EM. Aspiration versus cystectomy showed no evidence of a difference in CPR or the NMOR in one trial. One trial compared gonadotropin-releasing hormone (GnRH) agonist with GnRH antagonist. There was no evidence of a difference for clinical pregnancy rate, however the number of mature oocytes retrieved was greater with GnRH agonists.

Clinical comments

Date of latest search: 26 November 2010

Ədəbiyyat

1. Benschop L, Farquhar C, van der Poel N et al. Interventions for women with endometrioma prior to assisted reproductive technology. Cochrane Database Syst Rev 2010;(11):CD008571.