Content area
Full text
Introduction
The general prevalence of endometriosis is about 10 to 20%, with stage-specific prevalence ranging from 2% for stage 4 to 20% for stage 1 [1, 2]. The prevalence rate of endometriosis among women experiencing infertility is about 30 to 50% [2, 3–4]. Depending on the endometriosis site, it can be categorized into various subtypes, including endometrioma, deep infiltrating endometriosis (DIE), and superficial endometriosis [5, 6–7]. Around 17 to 44% of women with a diagnosis of endometriosis will develop an endometrioma, lesions that contain thick, dark brown fluid and are called chocolate cysts [4, 8].
Recent meta-analyses have indicated that both serum anti-Müllerian hormone (AMH) levels and antral follicle count (AFC) are significantly lower in patients with endometriomas when compared to other benign ovarian cysts or non-cystic ovaries [9, 10]. The ovulation rate in ovaries impacted by an endometrioma is lower than in the opposite unaffected ovary. The average ovulation rate in affected ovaries is 34.4 ± 6.6%, less than the anticipated rate of 50% in unaffected ovaries [11]. Assessing the reproductive outcomes of women with endometriomas who have not previously had adnexal surgery revealed a decreased response to ovarian stimulation, indicated by an increased cycle cancellation rate, a reduced number of retrieved m2 oocytes, but high-quality embryos, clinical pregnancy rate, implantation rate (IR) and live birth rate(LBR) were similar in women with and without endometrioma. The number of embryos varied in different studies [12, 13–14]. The surgical procedure for an endometrioma is still controversial. Although specific research indicates that surgically excising large endometriomas might enhance oocyte quality by lowering inflammation and clearing the ovarian environment, the surgery can also diminish ovarian reserve; clinicians should consider its risk-benefit balance [14, 15–16].
Although numerous studies examined the effect of endometriomas and their surgical treatment on reproductive characteristics and in vitro fertilization (IVF) outcomes, there is a scarcity of research with mixed results regarding the impact of endometrioma size on these factors. According to some studies, larger endometriomas (≥ 3–5 cm) at the time of IVF significantly decrease the number of oocytes retrieved and ovarian reserve compared with the contralateral healthy ovaries [17, 18–19]. However, in other studies, the larger size did not increase adverse IVF outcomes, including embryo quality [20].
Considering the conflicting and lack of evidence...