Endometriosis is a problem often associated with infertility. In my clinical practice I have seen many women with endometriosis who have to undergo a battery of investigations and try several treatment options to overcome the pain, dysmenorrhoea and infertility associated with endometriosis. A significant number of these women also present with cyst in their ovary which are called as endometrioma.
Endometriomas have most commonly been treated surgically. But, while surgical treatment for endometrioma is very common, surgical treatment has no clearly documented role in improving fertility of women undergoing surgical intervention for endometriotic cyst. Surgical treatment for endometrioma in infertile patients should be reserved only for a small section of young women, as it improves spontaneous pregnancy rate among young women. However, surgical treatment has no definitive advantage over expectant management in majority of women with endometrioma and it may actually reduce a woman’s ovarian reserve .Some of the other indications of surgical intervention in infertile women with endometrioma include cysts blocking access to ovary for egg retrieval during IVF, to treat concomitant pain symptoms or in cases where malignancy cant otherwise be ruled out with reasonable accuracy.
Women with endometrioma generally have lower ovarian reserve than their age matched control group. Therefore, I recommend proceeding directly to IVF in order to reduce time to pregnancy. Despite of a negative impact on ovarian reserve and ovarian responsiveness, the results of IVF treatment in women with infertility associated with endometrioma are comparable to overall results of IVF in women with tubal factor infertility.
This also holds true for all women with endometriosis associated infertility, especially when the disease is of significant severity. I recommend aggressive treatment of infertility in these women for the best outcomes, because the chances of spontaneous pregnancy in these women are rather low.
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