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Human Reproduction Update Advance Access originally published online on September 9, 2005
Human Reproduction Update 2006 12(1):57-64; doi:10.1093/humupd/dmi035
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© The Author 2005. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. for Permissions, please email: journals.permissions@oupjournals.org

Should endometriomas be treated before IVF–ICSI cycles?

Edgardo Somigliana1,3, Paolo Vercellini1,2, Paola Viganó1,2, Guido Ragni1 and Pier Giorgio Crosignani1,2

1 Department of Obstetrics, Gynecology and Neonatology, Ospedale Maggiore Policlinico, Mangiagalli and Regina Elena and 2 Università degli Studi di Milano, Milan, Italy

3 To whom correspondence should be addressed at: Department of Obstetrics, Gynecology and Neonatology, Ospedale Maggiore Policlinico, Mangiagalli and Regina Elena, Via Commenda 12, 20122 Milan, Italy. E-mail: dadosomigliana{at}yahoo.it

Submitted on April 1, 2005; revised on June 7, 2005; accepted on July 25, 2005

The laparoscopic excision of ovarian endometriomas appears to increase the chances of spontaneous conception, but the value of this treatment in women selected for IVF–ICSI cycles is debated. Studies recruiting women with unilateral disease and comparing ovarian responsiveness in the affected and contralateral intact gonads indicate that excision of endometriomas is associated with a quantitative damage to ovarian reserve. There are no randomized trials comparing laparoscopic excision to expectant management before IVF–ICSI cycles. The idea that surgery increases IVF pregnancy rates is not supported by the available evidence. However, the chance of conception is not the only issue that has to be considered. Some potential drawbacks are associated with both therapeutical strategies. Specifically, costs and hazard of surgical complications support expectant management whereas oocyte retrieval risks, the possibility of missing occult malignancy and endometriosis progression due to ovarian stimulation would favour surgical treatment. Alternative therapeutical options include medical treatment and ultrasound-guided aspiration. Whereas prolonged GnRH agonist down-regulation may be beneficial, data on ultrasound aspiration are more controversial.

Key words: endometrioma / endometriosis / IVF / laparoscopy / ovarian reserve


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