The Endometrioma Paradox

Overview

Journal JBRA Assist Reprod

Date 2025 Jan 28

PMID 39873421

Authors

Joao Antonio Dias Jr

Carlos Roberto Izzo

Georges Fassolas

Luiz Fernando de Oliveira Henrique

Gustavo Arantes Rosa Maciel

Sergio Podgaec

Luciana Carvalho Delamuta

Affiliations

Soon will be listed here.

Abstract

Endometriosis is a chronic disease that affects around 10% of reproductive age women worldwide and a common cause of infertility. One of its manifestations is ovarian endometriomas, which are present in 17-44% of endometriosis patients. Endometriomas can impair fertility by mechanical stretching and local inflammation, promoting oxidative stress in the surrounding ovarian cortex that could lead to apoptosis and necrosis of early follicles. The removal of endometriomas may improve spontaneous pregnancy rates, as already demonstrated by some studies. To reduce endometriomas recurrence, it is advised to perform cystectomy followed by hormonal suppression. However, this approach is unfeasible in patients desiring pregnancy. At the same time, cystectomy poses a threat to ovarian reserve and, therefore, to controlled ovarian stimulation. Women who have endometriomas surgically removed are at risk to have diminished response to ovarian stimulation if in vitro fertilization is needed in the future.

References

Vesali S, Razavi M, Rezaeinejad M, Maleki-Hajiagha A, Maroufizadeh S, Sepidarkish M . Endometriosis fertility index for predicting non-assisted reproductive technology pregnancy after endometriosis surgery: a systematic review and meta-analysis. BJOG. 2020; 127(7):800-809. DOI: 10.1111/1471-0528.16107. View

Hong S, Lee N, Kim S, Kim H, Jee B, Suh C . fertilization outcomes in women with surgery induced diminished ovarian reserve after endometrioma operation: Comparison with diminished ovarian reserve without ovarian surgery. Obstet Gynecol Sci. 2017; 60(1):63-68. PMC: 5313365. DOI: 10.5468/ogs.2017.60.1.63. View

Geber S, Ferreira D, Prates L, Sales L, Sampaio M . Effects of previous ovarian surgery for endometriosis on the outcome of assisted reproduction treatment. Reprod Biomed Online. 2002; 5(2):162-6. DOI: 10.1016/s1472-6483(10)61619-7. View

Becker C, Bokor A, Heikinheimo O, Horne A, Jansen F, Kiesel L . ESHRE guideline: endometriosis. Hum Reprod Open. 2022; 2022(2):hoac009. PMC: 8951218. DOI: 10.1093/hropen/hoac009. View

Alborzi S, Zahiri Sorouri Z, Askari E, Poordast T, Chamanara K . The success of various endometrioma treatments in infertility: A systematic review and meta-analysis of prospective studies. Reprod Med Biol. 2019; 18(4):312-322. PMC: 6780037. DOI: 10.1002/rmb2.12286. View

Maul L, Morrision J, Schollmeyer T, Alkatout I, Mettler L . Surgical therapy of ovarian endometrioma: recurrence and pregnancy rates. JSLS. 2014; 18(3). PMC: 4154409. DOI: 10.4293/JSLS.2014.00223. View

Adamson G, Pasta D . Endometriosis fertility index: the new, validated endometriosis staging system. Fertil Steril. 2009; 94(5):1609-15. DOI: 10.1016/j.fertnstert.2009.09.035. View

Jee B . Efficacy of ablation and sclerotherapy for the management of ovarian endometrioma: A narrative review. Clin Exp Reprod Med. 2022; 49(2):76-86. PMC: 9184881. DOI: 10.5653/cerm.2021.05183. View

Adamyan L, Kasyan V, Pivazyan L, Isaeva S, Avetisyan J . Laser vaporization compared with other surgical techniques in women with ovarian endometrioma: a systematic review and meta-analysis. Arch Gynecol Obstet. 2022; 308(2):413-425. DOI: 10.1007/s00404-022-06799-4. View

10.

Gonzalez-Foruria I, Soldevila P, Rodriguez I, Rodriguez-Purata J, Pardos C, Garcia S . Do ovarian endometriomas affect ovarian response to ovarian stimulation for IVF/ICSI?. Reprod Biomed Online. 2020; 41(1):37-43. DOI: 10.1016/j.rbmo.2020.03.013. View

11.

Maheux-Lacroix S, Nesbitt-Hawes E, Deans R, Won H, Budden A, Adamson D . Endometriosis fertility index predicts live births following surgical resection of moderate and severe endometriosis. Hum Reprod. 2017; 32(11):2243-2249. DOI: 10.1093/humrep/dex291. View

12.

Guzman L, Inoue N, Nunez D, Meza J, Bendezu P, Pino P . What advice should we give our patients to preserve their fertility and avoid needing oocyte donation in the future? - A Social Fertility Preservation program. JBRA Assist Reprod. 2019; 23(2):106-111. PMC: 6501754. DOI: 10.5935/1518-0557.20180088. View

13.

Alborzi S, Momtahan M, Parsanezhad M, Dehbashi S, Zolghadri J, Alborzi S . A prospective, randomized study comparing laparoscopic ovarian cystectomy versus fenestration and coagulation in patients with endometriomas. Fertil Steril. 2004; 82(6):1633-7. DOI: 10.1016/j.fertnstert.2004.04.067. View

14.

Yang C, Geng Y, Li Y, Chen C, Gao Y . Impact of ovarian endometrioma on ovarian responsiveness and IVF: a systematic review and meta-analysis. Reprod Biomed Online. 2015; 31(1):9-19. DOI: 10.1016/j.rbmo.2015.03.005. View

15.

Zeng C, Lu R, Li X, Kuai Y, Wang S, Xue Q . The presence of ovarian endometrioma adversely affect ovarian reserve and response to stimulation but not oocyte quality or IVF/ICSI outcomes: a retrospective cohort study. J Ovarian Res. 2022; 15(1):116. PMC: 9587543. DOI: 10.1186/s13048-022-01042-9. View

16.

Daniilidis A, Grigoriadis G, Kalaitzopoulos D, Angioni S, Kalkan U, Crestani A . Surgical Management of Ovarian Endometrioma: Impact on Ovarian Reserve Parameters and Reproductive Outcomes. J Clin Med. 2023; 12(16). PMC: 10455819. DOI: 10.3390/jcm12165324. View

17.

Haahr T, Esteves S, Humaidan P . Individualized controlled ovarian stimulation in expected poor-responders: an update. Reprod Biol Endocrinol. 2018; 16(1):20. PMC: 5845159. DOI: 10.1186/s12958-018-0342-1. View

18.

. Revised American Society for Reproductive Medicine classification of endometriosis: 1996. Fertil Steril. 1997; 67(5):817-21. DOI: 10.1016/s0015-0282(97)81391-x. View

19.

Hodgson R, Lee H, Wang R, Mol B, Johnson N . Interventions for endometriosis-related infertility: a systematic review and network meta-analysis. Fertil Steril. 2020; 113(2):374-382.e2. DOI: 10.1016/j.fertnstert.2019.09.031. View

20.

Leone Roberti Maggiore U, Gupta J, Ferrero S . Treatment of endometrioma for improving fertility. Eur J Obstet Gynecol Reprod Biol. 2016; 209:81-85. DOI: 10.1016/j.ejogrb.2016.02.035. View