Endometriosis and Assisted Reproductive Technologies: Maximizing Outcomes

Eric S. Surrey, MD


Semin Reprod Med. 2013;31(2):154-163. 

In This Article

Are Outcomes Affected by the Presence of an Endometrioma?

Although the presence of ovarian endometriotic cysts (endometriomas) should perhaps be addressed as an independent factor, it is difficult to truly assess the effect of these lesions on IVF outcome in isolation given that most of the patients with these lesions are likely to have concomitant peritoneal disease that could have an independent effect. The effect of endometrioma size per se has also not been evaluated as an independent variable.

Yanushpolsky et al reported a higher incidence of pregnancy loss, a decreased number of oocytes retrieved, as well as an adverse effect on embryo quality in endometrioma patients.[18] In contrast, Olivennes et al demonstrated no impact of endometriomas on any outcome parameter.[6] Several investigators described a decrease in ovarian response requiring the use of higher gonadotropin doses in patients with such lesions.[19,20] However, cumulative pregnancy and live-birth rates were unaffected.

Somigliana and colleagues reported that this effect was more marked in those patients with multiple and/or larger cysts.[20] In a more recent article, the same group compared the response of each ovary to gonadotropin stimulation in women with a unilateral endometrioma and noted that the development of follicles with a mean diameter >15 mm on the day of human chorionic gonadotropin administration was similar between the two sides.[21] This finding was confirmed by others.[22]

In a recent retrospective series, Ballester and coworkers reported that the total number of endometriomas, size of the largest lesions, and the presence of unilateral or bilateral lesions had no impact on cycle outcome.[23] However, the presence of concomitant deeply infiltrating disease also had a significant and deleterious effect on the cumulative likelihood of pregnancy. Serum anti-AMH level also was highly predictive, which would emphasize the importance of completing a thorough evaluation of ovarian reserve (as well at the rest of a thorough infertility evaluation) before initiating therapy.