Ovarian Endometrioma

Guidelines for Selection of Cases for Surgical Treatment or Expectant Management

Molly Carnahan; Jennifer Fedor; Ashok Agarwal; Sajal Gupta

Disclosures

Expert Rev of Obstet Gynecol. 2013;8(1):29-55. 

In This Article

Abstract and Introduction

Abstract

Ovarian endometrioma is a benign, estrogen-dependent cyst found in women of reproductive age. Infertility is associated with ovarian endometriomas; although the exact cause is unknown, oocyte quantity and quality are thought to be affected. The present research aims to analyze current treatment options for women with ovarian endometriomas, discuss the role of fertility preservation before surgical intervention in women with ovarian endometriomas and present guidelines for the selection of cases for surgery or expectant management. This review analyzed the factors of ovarian reserve, cyst laterality, size and location, patient age and prior surgical procedures. Based on these factors, the authors recommend three distinct treatment pathways: reproductive surgery to achieve spontaneous pregnancy following treatment, reproductive surgery to enhance IVF outcomes and expectant management with IVF.

Introduction

Endometriosis is a benign, estrogen-dependent gynecological disease characterized by endometrial tissue located outside the uterus. The disease affects approximately 5–10% of women of reproductive age in the USA, and symptoms include chronic pelvic pain, dysmenorrhea, dyspareunia and/or infertility.[1]

Approximately 17% of subfertile women have endometriomas, and it is estimated that 20–40% of women who undergo reproductive technology (ART) have endometriosis.[2] ART procedures are not only expensive – an average IVF cycle costs US$12,400 – but emotionally draining for the couple seeking treatment.[3] Therefore, it is important to understand how ovarian endometrioma affects fertility and ART procedures. Currently, there is no general consensus regarding the proper management of women with ovarian endometrioma who wish to conceive. This article aims to review and discuss the effects of ovarian endometriomas on fertility, analyze current treatment options, discuss the role of fertility preservation in women with ovarian endometriomas and present guidelines for the selection of cases for surgery or expectant management.

Comments

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