Large ovarian endometriomas
Abstract
The management of large endometriomas was described in a series of 814 patients. Combined therapy using gonadotrophin-releasing hormone agonist (GnRHa) and carbon dioxide laser laparoscopy was proposed. Drainage and GnRHa for 12 weeks provoked a reduction of the endometrioma size up to 50% of the initial value. After vaporization of the internal wall, a cumulative pregnancy of 51% after 1 year was achieved. A recurrence rate of 8% was observed for a follow-up of 2-11 years. Histological data demonstrated that the epithelium covering the ovary which is the mesothelium can invaginate in the ovarian cortex. Some of the invaginations were seen to be continuous with endometrial tissue, strongly suggesting the metaplasia theory in the pathogenesis of ovarian endometrioma.
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The impact of progestogens on morphology and vascularization of ectopic endometrial tissue and atrophy is questionable.
“the impact of progestogens on the morphology and vascularization of ectopic endometrial tissue and atrophy is much more questionable [77,78,79,80,81].”
From Endometriosis and Medical Therapy: From Progestogens to Progesterone Resistance to GnRH Antagonists: A Review (2021) · cites this paper as [78]
Some studies have revealed absence of proliferation index changes under progestogen therapy.
“Some studies have revealed the absence of proliferation index changes under progestogen therapy [77,78,79,80,81].”
From Endometriosis and Medical Therapy: From Progestogens to Progesterone Resistance to GnRH Antagonists: A Review (2021) · cites this paper as [78]
The reduction in lesion volume with estroprogestins or progestins is not predictable and not significant in the vast majority of cases.
“The reduction in lesion volume is not predictable and not significant in the vast majority of cases. Conflicting results have been observed [77,78,79,80,81,82,86,87,88].”
From Endometriosis and Medical Therapy: From Progestogens to Progesterone Resistance to GnRH Antagonists: A Review (2021) · cites this paper as [78]
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Research works printed but not linked: 4
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Cited by
Sorted by citations
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Endometriosis and infertility: a committee opinion
(2012) · Fertility and Sterility · doi:10.1016/j.fertnstert.2012.05.031 · Cited by 633 · see citing works
“While these and other observational studies suggest that, in women with Stage III/IV endometriosis who have no other identifiable infertility factors, conservative surgical treatment with laparoscopy and possible laparotomy may increase fertility (29), a possible adverse consequence is the loss of viable ovarian corte…”
ResultExcisional surgery versus ablative surgery for ovarian endometriomata
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“Donnez et al. (1996) have studied biopsies from 814 ovarian cysts.”
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“The precise prevalence of these alterations in endometriosis and their significance in terms of risk to undergo malignant transformation are not defined [12,14,16–19].”
BackgroundLaparoscopic excision of ovarian cysts: is the stripping technique a tissue-sparing procedure?
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Endometriomas as a possible cause of reduced ovarian reserve in women with endometriosis
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Self-citationManagement of ovarian endometriomas
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Enhanced follicular recruitment and atresia in cortex derived from ovaries with endometriomas
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“However, there are two main risks associated with the surgical treatment of endometriomas: [1] the risk of excessive surgery (removal or destruction of normal ovarian cortex together with the endometrioma) and [2] the risk of incomplete surgery (with subsequent early recurrence of endometriomas) (1, 2).”
BackgroundSelf-citationMatsuzaki, S., & Darcha, C. (2012) · Human Reproduction · doi:10.1093/humrep/der442 · Cited by 216 · see citing works
“However, the present study revealed significantly lower expression of vimentin in ovarian endometriosis compared with peritoneal and deep infiltrating lesions, in agreement with the results of a previous analysis by Donnez et al. (1996).”
ResultTsolakidis, D., Pados, G., Vavilis, D., Athanatos, D., Tsalikis, T., Giannakou, A., & Tarlatzis, B. C. (2009) · Fertility and Sterility · doi:10.1016/j.fertnstert.2009.01.138 · Cited by 216 · see citing works
“(13) published the largest series of treated endometriomas with the spectac-”
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“Donnez et al. suggested that not only is there no real plane of cleavage between the endometrialtype stroma and the ovarian cortex that would facilitate stripping, but also that it is not unusual to find oocytes in the vicinity of the endometrial stroma (Donnez et al., 1996).”
BackgroundSomigliana, E. (2003) · Human Reproduction · doi:10.1093/humrep/deg432 · Cited by 193 · see citing works
“Insights from IVF cycles”
BackgroundOvarian surgery for bilateral endometriomas influences age at menopause
Coccia, M. E., Rizzello, F., Mariani, G., Bulletti, C., Palagiano, A., & Scarselli, G. F. (2011) · Human Reproduction · doi:10.1093/humrep/der286 · Cited by 177 · see citing works
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Recurrence of ovarian endometrioma after laparoscopic excision
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Effect of endometrioma cystectomy on IVF outcome: a prospective randomized study
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Does ovarian surgery for endometriomas impair the ovarian response to gonadotropin?
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Dolmans, M., & Donnez, J. (2020) · Best Practice & Research Clinical Obstetrics & Gynaecology · doi:10.1016/j.bpobgyn.2020.06.011 · Cited by 148 · see citing works
Self-citationRecto vaginal septum adenomyotic nodules: a series of 500 cases
Donnez, J., Nisolle, M., Gillerot, S., Smets, M., Bassil, S., & Casanas‐Roux, F. (1997) · BJOG An International Journal of Obstetrics & Gynaecology · doi:10.1111/j.1471-0528.1997.tb12059.x · Cited by 150 · see citing works
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Self-citationImpact of ovarian endometrioma on assisted reproduction outcomes
Gupta, S., Agarwal, A. K., Agarwal, R., & de Mola, J. R. L. (2006) · Reproductive BioMedicine Online · doi:10.1016/s1472-6483(10)61439-3 · Cited by 148 · see citing works
Reoperation after laparoscopic treatment of ovarian endometriomas by excision and by fenestration
Saleh, A., & Tulandi, T. (1999) · Fertility and Sterility · doi:10.1016/s0015-0282(99)00243-5 · Cited by 142 · see citing works
Carmona, F., Martínez‐Zamora, M. Á., Rabanal, A., Martínez‐Román, S., & Balasch, J. (2011) · Fertility and Sterility · doi:10.1016/j.fertnstert.2011.04.068 · Cited by 145 · see citing works
Busacca, M., Chiaffarino, F., Candiani, M., Vignali, M., Bertulessi, C., Oggioni, G., & Parazzini, F. (2006) · American Journal of Obstetrics and Gynecology · doi:10.1016/j.ajog.2006.01.078 · Cited by 138 · see citing works
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“…the cyst wall can be excised with the stripping technique (Reich and McGlynn, 1986; Martin, 1991; Canis et al., 1992, Beretta et al., 1998) or ablated with bipolar coagulation or laser after cyst fenestration (Brosens et al., 1996; Donnez et al., 1996; Sutton et al., 1997; Beretta et al., 1998).”
BackgroundMethodInfluentialRoman, H., Tarta, O., Pura, I., Opris, I., Bourdel, N., Marpeau, L., & Sabourin, J. (2010) · Human Reproduction · doi:10.1093/humrep/deq069 · Cited by 139 · see citing works
“The inadvertent removal of endometrioma parenchyma during cystectomy has already been reported by numerous authors, and it appears to be a frequent occurrence (Donnez et al., 1996; Exacoustos et al., 2004).”
BackgroundMethodInfluentialMuzii, L., Bellati, F., Palaia, I., Plotti, F., Manci, N., Zullo, M. A., Angioli, R., & Panici, P. B. (2005) · Human Reproduction · doi:10.1093/humrep/dei007 · Cited by 137 · see citing works
“Several laparoscopic techniques have been described as alternatives for the endoscopic treatment of ovarian endometriomas: cyst wall laser vaporization preceded or not by medical therapy (Brosens et al., 1996; Donnez et al., 1996; Sutton et al., 1997), drainage and bipolar coagulation of the cyst wall (Beretta et al.”
BackgroundMethodInfluentialSurgical management of endometriosis
Donnez, J., Pirard, C., Smets, M., Jadoul, P., & Squifflet, J. (2004) · Best Practice & Research Clinical Obstetrics & Gynaecology · doi:10.1016/j.bpobgyn.2004.03.004 · Cited by 134 · see citing works
Histologic analysis of endometriomas: what the surgeon needs to know
Muzii, L., Bianchi, A., Bellati, F., Cristi, E., Pernice, M., Zullo, M. A., Angioli, R., & Panici, P. B. (2006) · Fertility and Sterility · doi:10.1016/j.fertnstert.2006.06.055 · Cited by 128 · see citing works
Busacca, M., & Vignali, M. (2003) · Current Opinion in Obstetrics & Gynecology · doi:10.1097/01.gco.0000084247.09900.4f · Cited by 128 · see citing works
Muzii, L., Achilli, C., Lecce, F., Bianchi, A., Franceschetti, S., Marchetti, C., Perniola, G., & Panici, P. B. (2015) · Fertility and Sterility · doi:10.1016/j.fertnstert.2014.12.101 · Cited by 127 · see citing works
Porpora, M. G., Pallante, D., Ferro, A., Crisafi, B., Bellati, F., & Panici, P. B. (2008) · Fertility and Sterility · doi:10.1016/j.fertnstert.2008.10.018 · Cited by 124 · see citing works
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“Donnez et al.[21] reported in their study of 814 cases of ovarian chocolate cysts that the cyst wall comprised flat endometrial interstitial epithelium and surrounded by fibrotic tissues containing hemosiderin‐rich macrophages.”
BackgroundFasciani, A. (2000) · Molecular Human Reproduction · doi:10.1093/molehr/6.1.50 · Cited by 120 · see citing works
“…data, in fact, have demonstrated that the mesothelium covering the ovary can invaginate in the ovarian cortex and that some of the invaginations are continuous with endometrial tissue, strongly suggesting that metaplastic histogenesis of ovarian endometriotic lesions occurs (Donnez et al., 1996).”
BackgroundRecommendations for the surgical treatment of endometriosis—part 1: ovarian endometrioma
Working group of ESGE, E., Sarıdoğan, E., Becker, C. M., Féki, A., Grimbizis, G., Hummelshøj, L., Keckstein, J., Nisolle, M., Tanos, V., Ulrich, U. A., et al. (2017) · Gynecological Surgery · doi:10.1186/s10397-017-1029-x · Cited by 110 · see citing works
“Following this initial step, administer a GnRH agonist (GnRHa) therapy for 3 months, during which time the thickness of the cyst wall significantly decreases, with atrophy and reduction in stromal vascularisation of the cyst [6].”
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Endometrioma Excision and Ovarian Reserve: A Dangerous Relation
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“Donnez [26] 1996 Retrospective study 81”
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An update on the diagnosis, surgical management, and fertility outcomes for women with endometrioma
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“In women with DIE and bowel involvement, a non-surgical approach with only ART resulted in a 29% pregnancy rate, whereas a surgical approach produced a 28% spontaneous pregnancy rate, and a combined pregnancy rate of 46% (54).”
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“Furthermore, it has been demonstrated that laser vaporization in the hands of an experienced surgeon is associated with good results both in terms of recurrence risk and pregnancy rate (13).”
BackgroundImplantation versus infiltration: the Sampson versus the endometriotic disease theory
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Epithelial Abnormalities in Cystic Ovarian Endometriosis
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“There are only a few reports in the literature regarding the clinical significance of hyperplasia and atypia in endometriosis [3–6, 13].”
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“Recently, techniques such as combining cystectomy and ablative surgery, or a three-stage procedure, have been used to reduce the damage that cystectomy causes to the ovaries (3, 4).”
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Excisional surgery versus ablative surgery for ovarian endometriomata: a Cochrane Review
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“In recent years, laparoscopy has become the gold standard for the treatment of ovarian endometriotic cysts (Daniell et al., 1991; Donnez et al., 1996; Sutton et al., 1997; Yuen et al., 1997).”
InfluentialThree Types of Endometriosis: Pathogenesis, Diagnosis and Treatment. State of the Art
Imperiale, L., Nisolle, M., Noël, J., & Fastrez, M. (2023) · Journal of Clinical Medicine · doi:10.3390/jcm12030994 · Cited by 99 · see citing works
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“Previous studies showed that up to 50% of the patients undergoing surgery for endometriomas might spontaneously conceive after laparoscopy [19–23].”
BackgroundManagement of endometriosis-related infertility: Considerations and treatment options
Lee, D.-Y., Kim, S., Lee, J. R., & Jee, B. (2020) · Clinical and Experimental Reproductive Medicine · doi:10.5653/cerm.2019.02971 · Cited by 73 · see citing works
“This has been a major concern regarding surgery as a treatment modality, and various attempts have been made to minimize the associated damage to ovarian tissue [42,43].”
BackgroundSerum CA-125 in Preoperative Patients at High Risk for Endometriosis
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“Endometriomas usually present themselves as pelvic masses arising from the growth of ectopic endometrial tissue within the ovary and are the most common ovarian cysts requiring surgery for the treatment [2].”
BackgroundYounis, J. S., Shapso, N., Ben-Sira, Y., Nelson, S. M., & Izhaki, I. (2021) · American Journal of Obstetrics and Gynecology · doi:10.1016/j.ajog.2021.06.102 · Cited by 88 · see citing works
Aspiration of ovarian endometriomas before intracytoplasmic sperm injection
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“We have demonstrated that treatment of ovarian endometriotic cysts by the ‘three-step procedure’ as described by Donnez is associated with an increase in AFC in the treated ovary 6 months after laparoscopy (Donnez et al., 1996).”
MethodAboulghar, M. A., Mansour, R., Serour, G. I., Al-Inany, H. G., & Aboulghar, M. M. (2003) · American Journal of Obstetrics and Gynecology · doi:10.1067/mob.2003.13 · Cited by 76 · see citing works
Laparoscopic management of ovarian endometriomas: a critical review of current practice
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National German Guideline (S2k): Guideline for the Diagnosis and Treatment of Endometriosis
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Determinants of short term recurrence rate of endometriosis
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“In a third study (Donnez et al., 1996), 814 women who presented with ovarian endometriomas received combined treatment with GnRH agonist and laparoscopic surgery.”
BackgroundSelf-citationDanilidis, A., Grigoriadis, G., Kalaitzopoulos, D. R., Angioni, S. L., Kalkan, Ü., Crestani, A., Merlot, B., & Roman, H. (2023) · Journal of Clinical Medicine · doi:10.3390/jcm12165324 · Cited by 72 · see citing works
Fertility Preservation in Women With Endometriosis
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Vaporization of ovarian endometrioma using plasma energy: histologic findings of a pilot study
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Clinical Aspects of Endometriosis
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Surgical treatment of ovarian endometriomas: state of the art?
Jadoul, P., Kitajima, M., Donnez, O., Squifflet, J. P., & Donnez, J. (2012) · Fertility and Sterility · doi:10.1016/j.fertnstert.2012.06.023 · Cited by 60 · see citing works
“Several arguments support this metaplasia theory (4, 5).”
Self-citationExcisional surgery versus ablative surgery for ovarian endometriomata
Hart, R. J., Hickey, M., Maouris, P., Buckett, W. M., & Garry, R. (2005) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd004992.pub2 · Cited by 61 · see citing works
Ovarian damage after laparoscopic endometrioma excision might be related to the size of cyst
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Management of Ovarian Endometrioma
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Pregnancy rates following ablative laparoscopic surgery for endometriomas
Jones, K., & Sutton, C. J. G. (2002) · Human Reproduction · doi:10.1093/humrep/17.3.782 · Cited by 59 · see citing works
Roman, H., Auber, M., Bourdel, N., Martin, C., Marpeau, L., & Pușcașiu, L. (2013) · Journal of Minimally Invasive Gynecology · doi:10.1016/j.jmig.2013.02.016 · Cited by 59 · see citing works
“Both have been shown to be comparable to the rates previously reported in women who underwent other surgical techniques [1–3,5,8].”
MethodResultĆorić, M., Barišić, D., Baldani, D. P., Karadža, M., & Banović, M. (2010) · Archives of Gynecology and Obstetrics · doi:10.1007/s00404-010-1676-x · Cited by 59 · see citing works
“There is also an „old“ three-stage technique of Donez et al (22) described in 1996 that became acceptable and showed its advantages over „classic“ laparoscopic stripping in the recent studies of Pados and Tsolakidis et al (16,23).”
MethodTreatment of endometrioma for improving fertility
Maggiore, U. L. R., Gupta, J. K., & Ferrero, S. (2016) · European Journal of Obstetrics & Gynecology and Reproductive Biology · doi:10.1016/j.ejogrb.2016.02.035 · Cited by 59 · see citing works
“The pathogenesis of endometrioma is controversial and three main theories have been proposed to explain its origin: invagination of ovarian cortex secondary to bleeding of superficial implants [4,5], invagination of the ovarian cortex secondary to metaplasia of coelomic epithelium in cortical inclusion cysts [6] and e…”
BackgroundCucinella, G., Granese, R., Calagna, G., Svelato, A., Saitta, S., Tonni, G., FRANCISCIS, P. D., Colacurci, N., & Perino, A. (2013) · Archives of Gynecology and Obstetrics · doi:10.1007/s00404-013-2841-9 · Cited by 56 · see citing works
“Conservative laparoscopic surgery is considered to be the gold standard for the treatment of ovarian endometriosis [12–17].”
BackgroundLi, S., Zhou, F., Zhu, H. Y., Huang, D., Jin, X. Y., Li, C., Dai, Y., Pan, Y., & Zhang, S. Y. (2017) · Biology of Reproduction · doi:10.1093/biolre/iox140 · Cited by 56 · see citing works
Canis, M. J., Mage, G., Wattiez, A., et al. (2003) · Human Reproduction · doi:10.1093/humrep/deg012 · Cited by 55 · see citing works
Mohamed, M. L., Nouh, A. A., El-Behery, M. M., et al. (2011) · International Journal of Gynecology & Obstetrics · doi:10.1016/j.ijgo.2011.01.010 · Cited by 53 · see citing works
“follicles [12,13].”
Recommendations for the Surgical Treatment of Endometriosis. Part 1: Ovarian Endometrioma†‡¶
Working group of ESGE, E. A. W., Sarıdoğan, E., Becker, C. M., Féki, A., Grimbizis, G., Hummelshøj, L., Keckstein, J., Nisolle, M., Tanos, V., Ulrich, U. A., et al. (2017) · Human Reproduction Open · doi:10.1093/hropen/hox016 · Cited by 63 · see citing works
“• Following this initial step, administer GnRH agonist (GnRHa) therapy for 3 months, during which time the thickness of the cyst wall significantly decreases, with atrophy and reduction in stromal vascularization of the cyst (Donnez et al., 1996).”
BackgroundSelf-citationdiZerega, G. S., Coad, J. E., & Donnez, J. (2006) · Fertility and Sterility · doi:10.1016/j.fertnstert.2006.07.1505 · Cited by 51 · see citing works
Self-citationLaparoscopic excision of deep endometriosis
Donnez, J., & Squifflet, J. P. (2004) · Obstetrics and Gynecology Clinics of North America · doi:10.1016/j.ogc.2004.06.006 · Cited by 49 · see citing works
Self-citationDonnez, J., Squifflet, J. P., Pirard, C., Jadoul, P., Wyns, C., & Smets, M. (2002) · Gynecologic and Obstetric Investigation · doi:10.1159/000066288 · Cited by 51 · see citing works
Self-citationLessey, B. A., Gordts, S., Donnez, O., Somigliana, E., Chapron, C., Garcia-Velasco, J. A., & Donnez, J. (2018) · Fertility and Sterility · doi:10.1016/j.fertnstert.2018.10.003 · Cited by 48 · see citing works
Self-citationAn Update on Surgical versus Expectant Management of Ovarian Endometriomas in Infertile Women
Keyhan, S., Hughes, C. L., Price, T. M., & Muasher, S. J. (2015) · BioMed Research International · doi:10.1155/2015/204792 · Cited by 46 · see citing works
Loo, T.-C., Lin, M. Y., Chen, S.-H., Chung, M., Tang, H.-H., Lin, L., & Tsai, Y.-C. (2005) · Journal of Assisted Reproduction and Genetics · doi:10.1007/s10815-005-5914-2 · Cited by 47 · see citing works
“In his series, 50% of pregnancy rate was obtained in IVF treatment after the surgery in a series of 814 cases (4).”
BackgroundDonnez, J., & Dolmans, M. (2021) · International Journal of Molecular Sciences · doi:10.3390/ijms222111342 · Cited by 49 · see citing works
Self-citationCandiani, M., Ottolina, J., Schimberni, M., Tandoi, I., Bartiromo, L., & Ferrari, S. (2020) · Journal of Minimally Invasive Gynecology · doi:10.1016/j.jmig.2019.07.027 · Cited by 44 · see citing works
Biases in the endometriosis literature
Koninckx, P. R. (1998) · European Journal of Obstetrics & Gynecology and Reproductive Biology · doi:10.1016/s0301-2115(98)00200-0 · Cited by 42 · see citing works
Fertility Preservation in Women with Endometriosis
Rangi, S. K., Hur, C. E., Richards, E. G., & Falcone, T. (2023) · Journal of Clinical Medicine · doi:10.3390/jcm12134331 · Cited by 45 · see citing works
Endometriosis in a patient with Rokitansky‐Kuster‐Hauser syndrome
Cho, M. K., Kim, C. H., & Oh, S.-T. (2009) · Journal of obstetrics and gynaecology research · doi:10.1111/j.1447-0756.2009.01025.x · Cited by 42 · see citing works
The ovarian endometrioma: why is it so poorly managed?: Indicators from an anonymous survey
Jones, K. (2002) · Human Reproduction · doi:10.1093/humrep/17.4.845 · Cited by 41 · see citing works
“If endometriotic cysts originate by implantation (Sampson, 1921, 1927; Hughesdon, 1957; Ishimura and Masuzaki, 1991; Brosens et al., 1996; Brosens, 1999) or metaplasia (Meyer, 1919, 1923; Donnez et al., 1994, 1996) then the aetiology of the condition is in the ovarian cortex.”
BackgroundMatsuzaki, S., Uehara, S., Murakami, T., Fujiwara, J., Funato, T., & Okamura, K. (2000) · Fertility and Sterility · doi:10.1016/s0015-0282(00)00712-3 · Cited by 41 · see citing works
Kovačević, V. M., Anđelić, L., & Jovanović, A. M. (2018) · Fertility and Sterility · doi:10.1016/j.fertnstert.2018.07.019 · Cited by 41 · see citing works
- Authors
- Donnez, J., Nisolle, M., Gillet, N., Smets, M., Bassil, S., & Casanas-Roux, F.
- Affiliations
- Cliniques Universitaires Saint-Luc (BE)
- Venue
- Human Reproduction
- Publisher
- Oxford University Press (OUP)
- Published
- 1996-03-01
- Volume
- 11
- Issue
- 3
- Pages
- 641-645
- ISSN
- 0268-1161 (ISSN-L)
- 1460-2350
- OpenAlex
- W1971732433
- Cited by
- 360
- References
- 0
- Citations by year
- 2026: 3 · 2025: 6 · 2024: 12 · 2023: 9 · 2022: 8 · 2021: 15 · 2020: 17 · 2019: 12 · 2018: 17 · 2017: 16 · 2016: 11 · 2015: 15 · 2014: 14 · 2013: 20 · 2012: 11
- FWCI
- 7.07
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Human Reproduction (publishedVersion)
- PubMed (publishedVersion)
- Digital Access to Libraries (submittedVersion)
- Open Repository and Bibliography (University of Liège) (submittedVersion)
- Topics
- Health Sciences › Medicine › Reproductive Medicine › Endometriosis Research and Treatment
- Health Sciences › Medicine › Obstetrics and Gynecology › Gynecological conditions and treatments
- Health Sciences › Medicine › Reproductive Medicine › Ovarian function and disorders
- Keywords
- endometrioma, GnRH agonist, carbon dioxide laser vaporization, laparoscopic surgery, pregnancy rate, recurrence, metaplasia
- MeSH terms
- Combined Modality Therapy, Endometriosis, Female, Humans, Infertility, Female, Gonadotropin-Releasing Hormone, Metaplasia, Ovarian Cysts, Ovarian Diseases, Pregnancy, Recurrence, Goserelin, Laser Therapy
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