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

• Published in: PloS one Vol. 12; no. 6; p. e0177426
• Main Authors: Tao, Xin, Chen, Lei, Ge, Shuqi, Cai, Lisi
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 02-06-2017; Public Library of Science (PLoS)
• Subjects: Biology and Life Sciences; Care and treatment; Childbirth & labor; Collaboration; Confidence intervals; Criteria; Cysts; Development and progression; Embryos; Endometriosis; Endometriosis - pathology; Endometriosis - surgery; Estrogens; Female; Fertilization in Vitro; Follicles; Gonadotropins; Gynecology; Hospitals; Humans; In vitro fertilization; Infertility; Laparoscopy; Libraries; Literature searches; Medical personnel; Medicine; Medicine and Health Sciences; Meta-analysis; Metabolism; Oocytes; Ovarian Neoplasms - pathology; Ovarian Neoplasms - surgery; Ovarian Reserve; Ovaries; Patients; People and Places; Physical Sciences; Physicians; Physiological aspects; Pituitary (anterior); Pregnancy; Quality; Reproductive health; Reproductive technologies; Reproductive technology; Research and Analysis Methods; Reviews; Search methods; Sperm; Sperm Injections, Intracytoplasmic; Standard deviation; Stimulation; Stripping; Studies; Surgery; Technology; Variance
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0177426

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.
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).
ART might be a better therapeutic method for ovarian endometrioma-related infertility than cystectomy.