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

Abstract

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.

Fig 1. Flowchart showing the study selection process.

Fig 2. Forrest plot of comparisons inter-patient. IV = inverse variance method; CI = confidence interval; M-H = mantel-Haenszel.

(a) Total amount of gonadotropin (Gn) used. (b) Duration of stimulation. (c) Estrogen (E) level on HCG day. (d) Number of mature or dominant follicle. (e) Total number of oocytes retrieved. (f) Total formed embryos. (g) Pregnancy rate. (h) Live birth rate.

Fig 3. Forrest plot of comparisons inta-patient. IV = inverse variance method; CI = confidence interval.

a: Number of mature or dominant follicle. b: Total number of oocytes retrieved.

Fig 4. Funnel plots illustrating pregnancy rate inter-patients.

SE = standard error; SMD = standard mean difference.