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Endometrioma, fertility, and assisted reproductive treatments

connecting the dots

Cecchino, Gustavo N.a,b,c; García-Velasco, Juan A.b,c

Current Opinion in Obstetrics and Gynecology: August 2018 - Volume 30 - Issue 4 - p 223–228
doi: 10.1097/GCO.0000000000000464

Purpose of review Surgery has traditionally been the primary treatment option for endometriosis-related infertility of any phenotype. However, advances and refinements of assisted reproductive technologies (ART) permit a more conservative approach in many scenarios. This review summarizes the latest findings in the field of reproductive medicine, which have supported a paradigm shift towards more conservative management of ovarian endometrioma.

Recent findings The presence of ovarian endometrioma per se is likely to impair ovarian reserve and alter ovarian functional anatomy. Conventional laparoscopic surgery is associated with significant risk of additional damage, and less invasive treatment approaches require further evaluation. With regard to infertile women with ovarian endometrioma who are scheduled for ART treatment, current data indicate that prior surgical intervention does not improve ART outcomes, and that controlled ovarian hyperstimulation (COH) does not affect quality of life or pain symptoms.

Summary Reproductive medicine physicians frequently encounter patients with ovarian endometrioma. The current evidence does not support the postponement of infertility treatment in favour of surgery, except in cases with severe symptoms or to improve follicle accessibility. Although these patients may exhibit diminished ovarian response to COH, their endometrial receptivity, aneuploidy rates, and fertility outcomes are similar to healthy controls. Surgery for ovarian endometrioma provides no benefits in ART treatments.

aDepartment of Gynecology, Federal University of São Paulo, São Paulo, São Paulo, Brazil

bDepartment of Gynecology and Obstetrics, Rey Juan Carlos University

cIVIRMA Madrid, Madrid, Spain

Correspondence to Gustavo N. Cecchino, IVI-Madrid, Rey Juan Carlos University, Madrid, Spain. Tel: +34 911 802 900; e-mail:

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