Results of in vitro fertilization in patients with endometriomas: Is surgical removal beneficial?

Objective The purpose of this study was to investigate the effect of endometriomas on clinical pregnancy rates of in vitro fertilization-embryo transfer. Study design Infertile patients with endometriosis who underwent in vitro fertilization–embryo transfer were divided into group 1 patients who had a history of ovarian endometriomas and group 2 patients who did not. The patients in group 1 were further divided into group 1A who had their endometriomas removed by laparoscopic ovarian cystectomy before the start of in vitro fertilization–embryo transfer and group 1B who underwent in vitro fertilization–embryo transfer with the presence of endometriomas. The clinical pregnancy rates of these groups were compared. Results Clinical pregnancy rates per transfer were similar in group 1 and group 2 (40% vs 47%; P = .38) and similar in patients in group 1A and group 1B (47% vs 34%; P = .28), although the direction was toward improved pregnancy rates in the groups of patients without endometriomas present at the time of in vitro fertilization stimulation. When patients >39 years of age were excluded, the overall pregnancy rate was higher in those patients who had no current endometriomas than in those patients who had endometriomas present at the time of stimulation (65% vs 39%; P = .05). For patients with unilateral endometriomas, similar numbers of mature oocytes were aspirated between the affected and unaffected ovaries. Conclusion Although the history of endometriomas does not appear to affect in vitro fertilization-embryo transfer outcomes adversely, there may be a benefit in the removal of endometriomas before in vitro fertilization.