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Cited by 65Endometriosis Research and TreatmentReproductive Biology and FertilityOvarian function and disorders

Is there a critical endometrioma size associated with reduced ovarian responsiveness in assisted reproduction techniques?

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Coccia, Maria Elisabetta, Rizzello, Francesca, Barone, Stefano, Pinelli, Sara, Rapalini, Erika, Parri, Cristiana, Caracciolo, Domenico, Papageorgiou, Savvas +2 more·2014·Reproductive BioMedicine Online
DOI 10.1016/j.rbmo.2014.04.019
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Abstract

This study investigated the relationships between ovarian endometrioma size, ovarian responsiveness and the number of retrieved oocytes following ovarian stimulation. A prospective study was conducted in a public clinical assisted reproduction centre. A total of 64 infertile women with monolateral endometriomas undergoing IVF or intracytoplasmic sperm injection were included in the study. The total number of follicles, number of follicles ≥ 16 mm and number of oocytes retrieved of ovaries containing endometrioma and normal ovaries were compared. Multivariate linear regression was used to assess whether number of follicles and collected oocytes varied by endometrioma size, age, basal FSH concentration. Significantly lower numbers of follicles ≥ 16 mm (P = 0.024) and oocytes retrieved (P = 0.001) in the ovaries containing endometrioma were observed. In patients with endometriomas ≥ 30 mm, endometrioma size was the most influential contributor to the total number of follicles and oocytes retrieved. Ovarian endometriomas result in reduced response to ovarian stimulation, compared with the response of the contralateral normal ovary in the same individual. In case of endometriomas <30 mm, basal FSH concentration remains the most important prognostic factor for oocyte retrieval.

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  • Current evidence shows no benefit of surgery for ovarian endometrioma prior to ART on live birth rates.

    “Clinicians are not recommended to routinely perform surgery for ovarian endometrioma prior to ART to improve live birth rates, as the current evidence shows no benefit and surgery is likely to have a negative impact on ovarian reserve (Coccia et al., 2014; Hamdan et al., 2015a; Nickkho-Amiry et al., 2018; Şükür et al., 2021).”

    From ESHRE guideline: endometriosis (2022) · cites this paper as Coccia et al., 2014

    The Discussion (p. 6) says evidence is insufficient to support either routine surgery or conservative management, while the Introduction (p. 2) describes possible damage to ovarian function from surgery. The paper does not establish that surgery before ART provides no live-birth benefit; its reported live-birth comparisons do not directly compare surgery with no surgery. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

  • Surgery for ovarian endometrioma prior to ART is likely to have a negative impact on ovarian reserve.

    “Clinicians are not recommended to routinely perform surgery for ovarian endometrioma prior to ART to improve live birth rates, as the current evidence shows no benefit and surgery is likely to have a negative impact on ovarian reserve (Coccia et al., 2014; Hamdan et al., 2015a; Nickkho-Amiry et al., 2018; Şükür et al., 2021).”

    From ESHRE guideline: endometriosis (2022) · cites this paper as Coccia et al., 2014

  • This seems unquestionable for large cysts, but may occur also in the case of small (<4 cm) endometriomas.

    “This seems unquestionable for large cysts (Coccia et al., 2014; Ferrero et al., 2017), but may occur also in the case of small (<4 cm) endometriomas (Benaglia et al., 2009).”

    From When more is not better: 10 ‘don’ts’ in endometriosis management. An ETIC* position statement (2019) · cites this paper as Coccia et al., 2014

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Research works printed but not linked: 47

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Cited by

Sorted by citations

Authors
Coccia, M. E., Rizzello, F., Barone, S., Pinelli, S., Rapalini, E., Parri, C., Caracciolo, D., Papageorgiou, S., Cima, G., & Gandini, L.
Affiliations
  • Ospedale Versilia (IT)
  • Sapienza University of Rome (IT)
Corresponding author
Rizzello, Francesca
ORCID
Venue
Reproductive BioMedicine Online
Publisher
Elsevier BV
Published
2014-08
Volume
29
Issue
2
Pages
259-266
ISSN
1472-6483 (ISSN-L)
DOI
10.1016/j.rbmo.2014.04.019
OpenAlex
W1970396547
Cited by
65
References
4
Citations by year
2026: 8 · 2025: 3 · 2024: 7 · 2023: 5 · 2022: 5 · 2021: 3 · 2020: 5 · 2019: 6 · 2018: 4 · 2017: 8 · 2016: 4 · 2015: 7
FWCI
7.68
Type
journal article
Language
en
Open access
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • Reproductive BioMedicine Online (publishedVersion)
  • PubMed (publishedVersion)
  • Florence Research (University of Florence) (submittedVersion)
  • IRIS Research product catalog (Sapienza University of Rome) (submittedVersion)
Topics
  • Health Sciences › Medicine › Reproductive Medicine › Endometriosis Research and Treatment
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Reproductive Biology and Fertility
  • Health Sciences › Medicine › Reproductive Medicine › Ovarian function and disorders
Keywords
endometrioma size, endometrioma, ovarian response, ovulation induction, oocyte retrieval, follicle count, in vitro fertilization, intracytoplasmic sperm injection, basal FSH, infertile women, contralateral ovary
MeSH terms
Adult, Endometriosis, Female, Follicle Stimulating Hormone, Humans, Ovary, Prospective Studies, Endometrial Neoplasms, Reproductive Techniques, Assisted

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