Optimizing infertility treatment for ovarian endometrioma: is surgical intervention preferable before or after in-vitro fertilization programs?

Abstract

Purpose

Endometriosis is one of the common endometrial pathologies that occurs in reproductive-age women and could lead to infertility. This study set out to observe which clinical management of endometriosis with endometrioma is prominent in improving IVF outcomes.

Materials and methods

This was a retrospective cross-sectional controlled study at Bunda General Hospital and Morula IVF Jakarta Clinic, Indonesia from Jan 2018 to Dec 2022. A total of 279 patients diagnosed with endometriosis were recorded. Of that, 86 couples with endometrioma underwent an in vitro fertilization program (IVF). Forty-eight women performed IVF prior to the removal of endometrioma through surgery (IVF-OPS) while the remaining underwent surgery for endometrioma removal followed by an IVF program (OPS-IVF). Each group was compared to the control group which was administered to an IVF program without the removal of endometriosis. The primary outcome was the clinical pregnancy rate. Mann–Whitney or Kruskal–Wallis and Chi square were used for statistical analysis. A p value of < 0.05 was considered statistically significant.

Results

A comparable clinical pregnancy rate was observed across the three groups (p = 0.068). Nonetheless, the IVF-OPS approach led to an improved number of top-quality blastocysts compared to both the control and OPS-IVF groups (p < 0.05). Eventually, IVF-OPS was shown to be a prominent approach for endometriosis with endometrioma management in comparison to OPS-IVF in terms of clinical pregnancy rate as well as embryology laboratory outcomes (p < 0.05).

Conclusion

Our result suggested that intervention of endometriosis with removal surgery was superior when performed after the IVF program.