Poor pregnancy outcome following assisted reproductive technology among women operated on for bilateral endometriomas
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ORIGINAL ARTICLE
Poor pregnancy outcome following assisted reproductive technology among women operated on for bilateral endometriomas Setsuko Yamamoto • Michiko Umeki Tomoko Maeda • Mina Yamaguchi • Teruhiro Hamano
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Received: 7 March 2009 / Accepted: 19 October 2009 / Published online: 17 November 2009 Ó Japan Society for Reproductive Medicine 2009
Abstract Purpose To determine the first line of infertility treatment for managing patients with unilateral or bilateral ovarian endometriomas. Methods We evaluated pregnancy outcome in patients who had received ovarian surgery for unilateral (Group U, n = 47) or bilateral endometriomas (Group B, n = 38) and aspiration with or without alcohol fixation for unilateral (Group u, n = 37) or bilateral endometriomas (Group b, n = 22). Subsequently, 64 of these women, excluding 29 dropouts, underwent assisted reproductive technology. We compared the clinical pregnancy rates of the four groups. Results The cumulative pregnancy rate after operation of Group B (18%) was significantly lower than that of a cystfree control group (n = 143; 44%) and Group U (43%). Group B had fewer oocytes fertilized during ART than did Group b (P \ 0.005) and fewer blastocysts available for transfer (P \ 0.005). The cumulative pregnancy rate of Group B was also lower than in Group b (P = 0.052). Conclusions Pregnancy outcomes of Group B were not better than for Group b. Therefore, encouraging such women to move directly to ART might help avoid ovarian damage and improve their ability to achieve a pregnancy. Keywords Endometriosis IVF Ovarian cystectomy Ovarian endometrioma Pregnancy outcome
S. Yamamoto (&) M. Umeki T. Maeda M. Yamaguchi T. Hamano ART Center, Fukuda Hospital, 2-2-6 Shin-machi, Kumamoto 860-0004, Japan e-mail: [email protected]
Introduction Ovarian endometriomas are found in 17–44% of patients with endometriosis [1]. Bilateral endometriomas are less frequent but are not rare, occurring in 19–28% of patients with this form of the disease [2]. Although there is a consensus that operative laparoscopy should be considered the first line treatment in symptomatic women with endometriomas [3, 4], there is ongoing debate on how to manage endometriomas before attempting assisted reproductive technology (ART) treatment. Some investigators have indicated that ovarian surgery might improve the fecundity of infertility patients with ovarian endometriomas [5, 6]. However, others have not reported improvements in pregnancy rate following surgical treatment in the context of ART [7]. Osuga et al. [8] reported that the 18-month cumulative pregnancy rate was 27.6% in patients with moderate or severe endometriosis. This means more than 70% of such women fail to recover their fecundity following laparoscopic surgery and ART treatment may be considered as the next step treatment for them. ART has been increasingly employed to help women with endometriosis to conceive. This is one of the main indications for such treatment and represents 10–25% of all ART patients. However, a prev
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