Weigh the pros and cons to ovarian reserve before stripping ovarian endometriomas prior to IVF/ICSI: A meta-analysis

PLOS ONE, Dec 2019

Purpose To explore the effects of conservative surgery for endometriomas on ovarian responsiveness during assisted reproductive technology (ART) and provide reproductive and gynecological doctors with a more reliable reference program for the treatment of endometriomas. Methods A literature search was performed by searching the PubMed, Embase, Cochrane Library, Web of Science and Science Direct databases. Studies with inter- and intra-patient comparisons of ovarian responses and oocyte quality between operated and unoperated ovaries and that met the inclusion criteria were retrieved, and the data from the outcome measures were extracted and pooled for this meta-analysis. Results Twenty-one published studies (2649 ART cycles) were included. The total amount of gonadotropin (Gn) used (inverse variance (IV):0.48; 95% confidence interval (CI): [0.13, 1.82], P = 0.0007) was significantly increased in the women with endometriomas who had a history of cystectomy. The estrogen (E) level on the day of hCG administration (IV: -0.29; 95% CI: [-0.41, -0.17], P<0.00001), the number of mature or dominant follicles (IV: -1.17; 95% CI: [-1.51, -0.82], P<0.00001) and the total number of oocytes retrieved (IV: -1.78; 95% CI: [-2.38, -1.17], P<0.00001) were significantly decreased in the women with endometriomas who had a history of cystectomy. The duration of stimulation (IV: 0.02; 95% CI: [-0.09, 0.13], P = 0.77), the total number of formed embryos (IV: -0.06; 95% CI: [-0.17, 0.04], P = 0.25), the pregnancy rate(IV:0.98;95%CI[0.82,1.18], P = 0.83) and the live birth rate(IV:0.93;95%CI[0.70,1.23], P = 0.61)were not statistically different between the two groups. Similar intra-patient results were found in the number of mature or dominant follicles (IV: -0.88; 95% CI: [-1.25, -0.52], P<0.00001) and the total number of oocytes retrieved (IV: -3.48; 95% CI: [-4.77, -2.19], P<0.00001). Conclusion ART might be a better therapeutic method for ovarian endometrioma-related infertility than cystectomy.

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Weigh the pros and cons to ovarian reserve before stripping ovarian endometriomas prior to IVF/ICSI: A meta-analysis

June Weigh the pros and cons to ovarian reserve before stripping ovarian endometriomas prior to IVF/ICSI: A meta-analysis Xin Tao 0 1 Lei Chen 0 1 Shuqi Ge 1 Lisi Cai 0 1 0 Center for Reproductive Medicine, the Third Affiliated Hospital of Sun-Yet Sen University , Guangzhou, Guangdong Province , China , 2 Department of Infertility and Sexual Medicine, the Third Affiliated Hospital of Sun-Yet Sen University , Guangzhou, Guangdong Province , China 1 Editor: Wan-Xi Yang, Zhejiang University College of Life Sciences , CHINA To explore the effects of conservative surgery for endometriomas on ovarian responsiveness during assisted reproductive technology (ART) and provide reproductive and gynecological doctors with a more reliable reference program for the treatment of endometriomas. A literature search was performed by searching the PubMed, Embase, Cochrane Library, Web of Science and Science Direct databases. Studies with inter- and intra-patient comparisons of ovarian responses and oocyte quality between operated and unoperated ovaries and that met the inclusion criteria were retrieved, and the data from the outcome measures were extracted and pooled for this meta-analysis. - Data Availability Statement: All relevant data are within the paper and its Supporting Information files. Funding: The authors received no specific funding for this work. Competing interests: The authors have declared that no competing interests exist. Purpose Methods Results Twenty-one published studies (2649 ART cycles) were included. The total amount of gonadotropin (Gn) used (inverse variance (IV):0.48; 95% confidence interval (CI): [0.13, 1.82], P = 0.0007) was significantly increased in the women with endometriomas who had a history of cystectomy. The estrogen (E) level on the day of hCG administration (IV: -0.29; 95% CI: [-0.41, -0.17], P<0.00001), the number of mature or dominant follicles (IV: -1.17; 95% CI: [-1.51, -0.82], P<0.00001) and the total number of oocytes retrieved (IV: -1.78; 95% CI: [-2.38, -1.17], P<0.00001) were significantly decreased in the women with endometriomas who had a history of cystectomy. The duration of stimulation (IV: 0.02; 95% CI: [-0.09, 0.13], P = 0.77), the total number of formed embryos (IV: -0.06; 95% CI: [-0.17, 0.04], P = 0.25), the pregnancy rate(IV:0.98;95%CI[0.82,1.18], P = 0.83) and the live birth rate(IV:0.93;95% CI[0.70,1.23], P = 0.61)were not statistically different between the two groups. Similar intrapatient results were found in the number of mature or dominant follicles (IV: -0.88; 95% CI: [-1.25, -0.52], P<0.00001) and the total number of oocytes retrieved (IV: -3.48; 95% CI: [-4.77, -2.19], P<0.00001). Conclusion ART might be a better therapeutic method for ovarian endometrioma-related infertility than cystectomy. Introduction Ovarian endometriomas are one of the most common benign lesions in gynecology and mainly occur in reproductive-aged women. For women with endometriomas and a strong desire to become pregnant, conservative surgery to save fertility is usually performed. Endometriomas in infertile patients have been a clinical challenge for infertility specialists. These patients often present with infertility and are eager to achieve their reproductive needs through assisted reproductive technology (ART). The most common ART approaches are in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) with embryo transfer. However, whether ovarian surgical interventions will reduce ovarian reserves and responsiveness to stimulation is still a controversial issue. Some studies have shown that endometriomas will not damage ovarian reserves[ 1 ] and rarely damages oocyte quality[ 2 ]. Moreover, the excision of endometriomas can improve the success rate of ART[ 3 ]. However, other studies have supported the opposite view and found that endometrioma cystectomies may damage the ovarian response to controlled ovarian hyperstimulation (COH) and weaken the ovarian reserves[4±7]. Another study showed that the existence of an endometrioma affects iron metabolism in follicular fluid, increases the amount of oxygen free radicals and results in egg quality injury[ 8 ]. To better explore the effect of conservative endometrioma surgery and provide a more reliable reference program for reproductive and gynecological doctors in the treatment of endometriomas, this systematic review and meta-analysis conducted inter-patient comparisons of the outcomes of patients with or without cystectomy and intra-patient comparisons in patients with unilateral disease between the ovary that underwent the intervention and the intact ovary. Search strategy The literature search was performed from January 2001 to July 2016, and related studies were identified by searching the PubMed, Embase, Cochrane Library, Web of Science and Science Direct databases. The following search terms and their combinations were used: endometrioma/endometriosis ovarian cysts, cystectomy/surgical (...truncated)


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Xin Tao, Lei Chen, Shuqi Ge, Lisi Cai. Weigh the pros and cons to ovarian reserve before stripping ovarian endometriomas prior to IVF/ICSI: A meta-analysis, PLOS ONE, 2017, Volume 12, Issue 6, DOI: 10.1371/journal.pone.0177426