CoChat
Sign Up
Cited by 47Endometriosis Research and TreatmentGynecological conditions and treatmentsEctopic Pregnancy Diagnosis and Management

Surgery versus conservative management of endometriomas in subfertile women. A systematic review

Open access
Brink Laursen, Jacob, Schroll, Jeppe B., Macklon, Kirsten T., Rudnicki, Martin·2017·Acta Obstetricia et Gynecologica Scandinavica
DOI 10.1111/aogs.13154
Open this paper in CoChat — free accountOpen PDF

Abstract

Introduction: Endometriomas are present in up to 44% of all women with endometriosis and have a detrimental effect on fertility. However, it is controversial whether endometriomas should be surgically removed before assisted reproduction technology. Our purpose was to evaluate whether surgical stripping of endometriomas in subfertile women improves the chance of a live birth. Secondary outcomes were impact on ovarian reserve and pain. Material and methods: We conducted a systematic review and meta‐analysis with results reported in accordance to the PRISMA guidelines. A summary of findings table was developed using GRADE. We searched Medline and Embase. Two reviewers performed the screening. Results: Of 686 manuscripts, we included one randomized controlled trial and nine retrospective cohort studies, mostly of low quality. The odds ratio for live birth after surgery [compared with conservative management before in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI)] was 0.87 (95% CI 0.64–1.18, six studies, I2 = 3%; ⨁◯◯◯, VERY LOW quality). The mean difference of antral follicle count was −2.09 (95% CI −4.84 to 0.67, four studies). No difference was observed regarding antral follicle count between the two groups (MD −2.09, 95% CI −4.84 to 0.67, four studies, ⨁◯◯◯, VERY LOW quality). Pain outcome was not reported in the included studies. Conclusion: The very low quality evidence suggests no difference in odds ratio of live birth between women who underwent surgery for endometriomas before IVF/ICSI compared with conservative management. Further high quality studies are needed, but due to a lack of convincing evidence favoring surgery, we recommend considering conservative treatment if the only indication is subfertility.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1111/aogs.13154

Cites

5 of 5 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • According to the results of systematic literature reviews, surgical excision of small endometriomas before IVF is associated with a need for higher amounts of gonadotrophins, lower peripheral estrogens levels, reduced number of follicles, and lower number of oocytes retrieved, but no effect on the chances of pregnancy.

    “In fact, according to the results of systematic literature reviews, surgical excision of small endometriomas before IVF is associated with a need for higher amounts of gonadotrophins, lower peripheral estrogens levels, reduced number of follicles, and lower number of oocytes retrieved, but no effect on the chances of pregnancy (Brink Laursen et al., 2017; Tao et al., 2017; Nickkho-Amiry et al., 2”

    From When more is not better: 10 ‘don’ts’ in endometriosis management. An ETIC* position statement (2019) · cites this paper as Brink Laursen et al., 2017

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

Flagged first, then by citations

Research works printed but not linked: 29

  1. Eskenazi B, Warner ML. Epidemiology of endometriosis. Obstet Gynecol Clin North Am. 1997;24:235-58.
  2. Ozkan S, Murk W, Arici A. Endometriosis and infertility. Ann N Y Acad Sci. 2008;1127:92-100.
  3. Houston DE, Noller KL, Melton LJ, Selwyn BJ, Hardy RJ. Incidence of pelvic endometriosis in Rochester, Minnesota, 1970-1979. Am J Epidemiol. 1987;125:959-69.
  4. Alborzi S, Keramati P, Younesi M, Samsami A, Dadras N. The impact of laparoscopic cystectomy on ovarian reserve in patients with unilateral and bilateral endometriomas. Fertil Steril. 2014;101:427-34.
  5. Gupta S, Agarwal A, Agarwal R, de Mola JRL. Impact of ovarian endometrioma on assisted reproduction outcomes. Reprod Biomed Online. 2006;13:349-60.
  6. Kuroda M, Kuroda K, Arakawa A, Fukumura Y, Kitade M, Kikuchi I, et al. Histological assessment of impact of ovarian endometrioma and laparoscopic cystectomy on ovarian reserve. J Obstet Gynaecol Res. 2012;38:1187- 93.
  7. Cranney R, Condous G, Reid S. An update on the diagnosis, surgical management, and fertility outcomes for women with endometrioma. Acta Obstet Gynecol Scand. 2017;96:633-43.
  8. Practice Committee of the American Society for Reproductive Medicine. Testing and interpreting measures of ovarian reserve: a committee opinion. Fertil Steril. 2015;103:e9-17.
  9. Somigliana E, Berlanda N, Benaglia L, Vigan o P, Vercellini P, Fedele L. Surgical excision of endometriomas and ovarian reserve: a systematic review on serum antim€ ullerian hormone level modifications. Fertil Steril. 2012;98:1531-8.
  10. Streuli I, de Ziegler D, Gayet V, Santulli P, Bijaoui G, de Mouzon J, et al. In women with endometriosis anti- M€ ullerian hormone levels are decreased only in those with previous endometrioma surgery. Hum Reprod. 2012;27:3294-303.
  11. Muzii L, Tucci CD, Feliciantonio MD, Marchetti C, Perniola G, Panici PB. The effect of surgery for endometrioma on ovarian reserve evaluated by antral follicle count: a systematic review and meta-analysis. Hum Reprod. 2014;29:2190-8.
  12. Dan H, Limin F. Laparoscopic ovarian cystectomy versus fenestration/coagulation or laser vaporization for the treatment of endometriomas: a meta-analysis of randomized controlled trials. Gynecol Obstet Invest. 2013;76:75-82.
  13. Covidence -Accelerate your systematic review. Available online at: https://www.covidence.org/ (accessed November 03, 2016).
  14. Higgins JPT, Altman DG, Gotzsche PC, Juni P, Moher D, Oxman AD, et al. The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ. 2011;343: d5928.
  15. Tinkanen H, Kujansuu E. In vitro fertilization in patients with ovarian endometriomas. Acta Obstet Gynecol Scand. 2000;79:119-22.
  16. Pabuccu R, Onalan G, Kaya C. GnRH agonist and antagonist protocols for stage I-II endometriosis and endometrioma in in vitro fertilization/intracytoplasmic sperm injection cycles. Fertil Steril. 2007;88: 832-9.
  17. Bongioanni F, Revelli A, Gennarelli G, Guidetti D, Delle Piane LD, Holte J. Ovarian endometriomas and IVF: a retrospective case-control study. Reprod Biol Endocrinol. 2011;9:81.
  18. Benaglia L, Candotti G, Busnelli A, Paffoni A, Vercellini P, Somigliana E. Antral follicle count as a predictor of ovarian responsiveness in women with endometriomas or with a history of surgery for endometriomas. Fertil Steril. 2015;103:1544-50.
  19. Dong X, Wang R, Zheng Y, Xiong T, Liao X, Huang B, et al. Surgical treatment for endometrioma does not increase clinical pregnancy rate or live birth/ongoing pregnancy rate after fresh IVF/ICSI treatment. Am J Transl Res. 2014;6:163.
  20. Lee K-H, Kim C-H, Lee Y-J, Kim S-H, Chae H-D, Kang B-M. Surgical resection or aspiration with ethanol sclerotherapy of endometrioma before in vitro fertilization in infertilie women with endometrioma. Obstet Gynecol Sci. 2014;57:297.
  21. Kuroda K, Kitade M, Kikuchi I, Kumakiri J, Matsuoka S, Kuroda M, et al. The impact of endometriosis, endometrioma and ovarian cystectomy on assisted reproductive technology. Reprod Med Biol. 2009;8:113-8.
  22. Garcia-Velasco JA, Mahutte NG, Corona J, Z uñiga V, Gil es J, Arici A, et al. Removal of endometriomas before in vitro fertilization does not improve fertility outcomes: a matched, case-control study. Fertil Steril. 2004;8:1194-7.
  23. Wong BC, Gillman NC, Oehninger S, Gibbons WE, Stadtmauer LA. Results of in vitro fertilization in patients with endometriomas: is surgical removal beneficial? Am J Obstet Gynecol. 2004;191:597-605.
  24. Hamdan M, Dunselman G, Li TC, Cheong Y. The impact of endometrioma on IVF/ICSI outcomes: a systematic review and meta-analysis. Hum Reprod Update. 2015;21:809-25.
  25. Donato ND, Seracchioli R. How to evaluate adenomyosis in patients affected by endometriosis? Minim Invasive Surg. 2014;2014:507230.
  26. Broekmans FJ, Kwee J, Hendriks DJ, Mol BW, Lambalk CB. A systematic review of tests predicting ovarian reserve and IVF outcome. Hum Reprod Update. 2006;12:685-718.
  27. Asgari Z, Rouholamin S, Hosseini R, Sepidarkish M, Hafizi L, Javaheri A. Comparing ovarian reserve after laparoscopic excision of endometriotic cysts and hemostasis achieved either by bipolar coagulation or suturing: a randomized clinical trial. Arch Gynecol Obstet. 2016;293:1015-22.
  28. Whiteside JL, Falcone T. Endometriosis-related pelvic pain: what is the evidence? Clin Obstet Gynecol. 2003;46:824-30.
  29. Shamseer L, Moher D, Clarke M, Ghersi D, Liberati A, Petticrew M, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015: elaboration and explanation. BMJ. 2015;349:g7647.

Cited by

Sorted by citations

Authors
Brink Laursen, J., Schroll, J. B., Macklon, K. T., & Rudnicki, M.
Affiliations
  • Department of Obstetrics and Gynecology Zealand University Hospital Copenhagen University Roskilde Denmark
  • Herlev Hospital (DK)
  • Copenhagen University Hospital (DK)
  • Odense University Hospital (DK)
ORCID
Venue
Acta Obstetricia et Gynecologica Scandinavica
Publisher
Wiley
Published
2017-05-28
Volume
96
Issue
6
Pages
727-735
ISSN
  • 0001-6349 (ISSN-L)
  • 1600-0412
DOI
10.1111/aogs.13154
OpenAlex
W2606947754
Cited by
47
References
5
Citations by year
2026: 1 · 2025: 3 · 2024: 3 · 2023: 6 · 2022: 9 · 2021: 8 · 2020: 6 · 2019: 3 · 2018: 5 · 2017: 3
FWCI
0.76
Type
journal article
Language
en
Open access
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations
  • Acta Obstetricia Et Gynecologica Scandinavica (publishedVersion)
  • PubMed (publishedVersion)
  • University of Southern Denmark Research Portal (University of Southern Denmark) (publishedVersion)
Topics
  • Health Sciences › Medicine › Reproductive Medicine › Endometriosis Research and Treatment
  • Health Sciences › Medicine › Obstetrics and Gynecology › Gynecological conditions and treatments
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Ectopic Pregnancy Diagnosis and Management
Keywords
endometrioma, endometriosis, subfertility, cytoreductive surgery, conservative treatment, assisted reproduction, in vitro fertilization, intracytoplasmic sperm injection, live birth rate, ovarian reserve, antral follicle count
MeSH terms
Conservative Treatment, Endometriosis, Female, Fertilization in Vitro, Humans, Infertility, Female, Ovulation Induction, Pregnancy, Pregnancy Rate, Sperm Injections, Intracytoplasmic, Reproductive Techniques, Assisted

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review