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Spontaneous pregnancy rates after laparoscopic surgery for ovarian endometriomas

Spontaneous pregnancy rates after laparoscopic surgery for ovarian endometriomas. Ertan SARIDO Ğ AN Consultant in Reproductive Medicine and Minimal Access Surgery University College London Hospitals. Endometriosis and infertility association. Controversial Endometriosis is present

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Spontaneous pregnancy rates after laparoscopic surgery for ovarian endometriomas

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  1. Spontaneous pregnancy rates after laparoscopic surgery for ovarian endometriomas Ertan SARIDOĞAN Consultant in Reproductive Medicine and Minimal Access Surgery University College London Hospitals

  2. Endometriosis and infertility association • Controversial • Endometriosis is present • ~5-10% of general population • ~4% fertile women • ~13.5% of infertile population

  3. Advanced endometriosis and infertility • Tubal obstruction • Distal obstruction • Proximal obstruction • Hydrosalpinx • Perituboovarian adhesions, reducing tubal motility and limiting access to ovarian surface • Ovarian endometriomas • Reduced coital frequency due to pain

  4. What about chances of spontaneous pregnancy after surgery ? • Do the chances improve ? • Are there additional benefits ? • Pain • Benefit for IVF • Are there potential hazards ?

  5. Pregnancy rates after surgery for endometriomasVercellini et al 2009

  6. Pregnancy after surgery and ASRM stageVercellini et al 2006

  7. Hart et al 2009

  8. Ovarian cystectomy and IVF

  9. Demirol et al 2006

  10. Demirol et al 2006

  11. Endometriomas: to touch or not to touchGarcia-Velasco & Somigliana 2009

  12. Conclusions • Surgery for ovarian endometrioma improves fertility • Ovarian cystectomy is superior to drainage+ablation in achieving spontaneous pregnancies • There is a possibility of an over estimation of effect • Endometrioma surgery may reduce ovarian reserve • Endometrioma surgery prior to IVF may reduce ovarian response without improving pregnancy rates • There is a good argument for offering surgery to most patients as the primary option, followed by IVF treatment

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