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Meta-Analysis
. 2021 Jan;303(1):3-16.
doi: 10.1007/s00404-020-05796-9. Epub 2020 Sep 26.

The impact of endometrioma on in vitro fertilisation/intra-cytoplasmic injection IVF/ICSI reproductive outcomes: a systematic review and meta-analysis

Sallwa M Alshehre  1   2 , Brenda F Narice  3 , Mark A Fenwick  3 , Mostafa Metwally  4
Affiliations
Meta-Analysis

The impact of endometrioma on in vitro fertilisation/intra-cytoplasmic injection IVF/ICSI reproductive outcomes: a systematic review and meta-analysis

Sallwa M Alshehre et al. Arch Gynecol Obstet. 2021 Jan.

Abstract

Background: Assisted reproductive technologies (ART) such as in vitro fertilisation (IVF) and intra-cytoplasmic sperm injection (ICSI) are often used to aid fertility in women with endometrioma; however, the implications of endometrioma on ART are unresolved.

Objective: To determine the effect of endometrioma on reproductive outcomes in women undergoing IVF or ICSI.

Methods: A systematic review and meta-analysis was conducted to identify articles examining women who had endometrioma and had undergone IVF or ICSI. Electronic searches were performed in PubMed, BIOSIS and MEDLINE up to September 2019. The primary outcome was live birth rate (LBR). Secondary outcomes included clinical pregnancy rate (CPR), implantation rate (IR), number of oocytes retrieved, number of metaphase II (MII) oocytes retrieved, number of embryos and top-quality embryos and the duration of gonadotrophin stimulation and dose.

Results: Eight studies were included. Where significant heterogeneity between studies was identified, a random-effects model was used. The number of oocytes (weighted means difference; WMD-2.25; 95% CI 3.43 to - 1.06, p = 0.0002) and the number of MII oocytes retrieved (WMD-4.64; 95% CI 5.65 to - 3.63, p < 0.00001) were significantly lower in women with endometrioma versus controls. All other outcomes, including gonadotrophin dose and duration, the total number of embryos, high-quality embryos, CPR, IR and LBR were similar in women with and without endometrioma.

Conclusion: Even though women with endometriomas had a reduced number of oocytes and MII oocytes retrieved when compared to women without, no other differences in reproductive outcomes were identified. This implies that IVF/ICSI is a beneficial ART approach for women with endometrioma.

Keywords: Endometrioma; Fertility; IVF/ICSI; Oocyte; Reproductive outcomes.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
PRISMA chart of the literature search
Fig. 2
Fig. 2
a Forest plot reporting the odds ratio (OR) between the endometrioma and control for live birth rate. b Forest plot reporting the OR between the endometrioma and control for clinical pregnancy rate. c Forest plot reporting the OR between the endometrioma and control for implantation rate. d Forest plot reporting the weighted mean difference (WMD) between endometrioma and control for the total amount of gonadotropin consumption. e Forest plot reporting the WMD between the endometrioma and control for the duration of gonadotropin stimulation. f Forest plot reporting the WMD between the endometrioma and control in the number of oocytes retrieved. g Forest plot reporting the WMD between the endometrioma and control for the number of MII oocytes. h Forest plot reporting the WMD between the endometrioma and control for the number of embryos. i Forest plot reporting the WMD between endometrioma and control for the number of high-quality embryos
Fig. 2
Fig. 2
a Forest plot reporting the odds ratio (OR) between the endometrioma and control for live birth rate. b Forest plot reporting the OR between the endometrioma and control for clinical pregnancy rate. c Forest plot reporting the OR between the endometrioma and control for implantation rate. d Forest plot reporting the weighted mean difference (WMD) between endometrioma and control for the total amount of gonadotropin consumption. e Forest plot reporting the WMD between the endometrioma and control for the duration of gonadotropin stimulation. f Forest plot reporting the WMD between the endometrioma and control in the number of oocytes retrieved. g Forest plot reporting the WMD between the endometrioma and control for the number of MII oocytes. h Forest plot reporting the WMD between the endometrioma and control for the number of embryos. i Forest plot reporting the WMD between endometrioma and control for the number of high-quality embryos
Fig. 3
Fig. 3
Funnel plot for studies comparing the mean number of oocytes retrieved from endometrioma patients versus control
See this image and copyright information in PMC

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