Endometriotic ovarian cysts do not negatively affect the rate of spontaneous ovulation.

STUDY QUESTION Do endometriotic ovarian cysts influence the rate of spontaneous ovulation? SUMMARY ANSWER Endometriotic cysts, no matter what their volume, do not influence the rate of spontaneous ovulation in the affected ovary. WHAT IS KNOWN ALREADY Endometriotic ovarian cysts may negatively affect spontaneous ovulation in the affected ovary. STUDY DESIGN, SIZE, DURATION This was a prospective observational study performed between September 2009 and June 2013. PARTICIPANTS/MATERIALS, SETTING, METHODS This study included women of reproductive age with regular menstrual cycles and unilateral ovarian endometriomas (diameter ≥20 mm) desiring to conceive. Exclusion criteria were: hormonal therapies in the 3 months prior to study entry and previous adnexal surgery. Patients underwent serial transvaginal ultrasound to assess the side of ovulation (for up to six cycles). MAIN RESULTS AND THE ROLE OF CHANCE Ovulation was monitored in 1199 cycles in 244 women (age, mean ± SD, 34.3 ± 4.9 years). 55.3% of the patients had left endometriomas and 44.7% had right endometriomas (P = 0.024). The mean (±SD) diameter of the endometriomas was 5.3 cm (±1.7 cm). Ultrasonographically documented ovulation occurred in 596 cycles in the healthy ovary (49.7%; 95% CI, 46.8-52.6%) and in 603 cycles in the affected ovary (50.3%; 95% CI, 47.1-53.2%; P = 0.919). This observation was confirmed in patients with diameter of the cyst ≥4 cm (n = 166) and in those with diameter of the cyst ≥6 cm (n = 45). One hundred and five patients spontaneously conceived (43.0%; 95% CI, 36.7-49.5%). LIMITATIONS, REASON FOR CAUTION The high pregnancy rate reported in this study was observed in a selected population of women with endometriomas and cannot be extrapolated to all patients with endometriosis. WIDER IMPLICATIONS OF THE FINDINGS Since ovarian endometriomas do not impair spontaneous ovulation, the impact on fertility of surgical excision of ovarian endometriomas should be further investigated.

[1]  S. Ferrero,et al.  Norethisterone acetate versus norethisterone acetate combined with letrozole for the treatment of ovarian endometriotic cysts: a patient preference study. , 2013, European journal of obstetrics, gynecology, and reproductive biology.

[2]  S. Amer,et al.  Long-term reproductive performance after surgery for ovarian endometrioma. , 2014, European journal of obstetrics, gynecology, and reproductive biology.

[3]  E. Sarıdoğan,et al.  Ultrasound mapping of pelvic endometriosis: does the location and number of lesions affect the diagnostic accuracy? a multicentre diagnostic accuracy study , 2013, BMC Women's Health.

[4]  A. Paccapelo,et al.  Do Low-Dose Oral Contraceptives have an Effect on Ovarian Endometrioma Diameter and Endometriosis Symptoms? , 2013 .

[5]  L. Fedele,et al.  The vanishing endometrioma: the intriguing impact of pregnancy on small endometriotic ovarian cysts , 2013, Gynecological endocrinology : the official journal of the International Society of Gynecological Endocrinology.

[6]  B. Ata,et al.  Prospective assessment of the impact of endometriomas and their removal on ovarian reserve and determinants of the rate of decline in ovarian reserve. , 2013, Human reproduction.

[7]  P. Vercellini,et al.  Surgical excision of endometriomas and ovarian reserve: a systematic review on serum antimüllerian hormone level modifications. , 2012, Fertility and sterility.

[8]  S. Ferrero,et al.  Hemostasis by bipolar coagulation versus suture after surgical stripping of bilateral ovarian endometriomas: a randomized controlled trial. , 2012, Journal of minimally invasive gynecology.

[9]  M. Metwally,et al.  The impact of excision of ovarian endometrioma on ovarian reserve: a systematic review and meta-analysis. , 2012, The Journal of clinical endocrinology and metabolism.

[10]  O. Abulafia,et al.  Medical management of recurrent endometrioma with long-term norethindrone acetate , 2012, International journal of women's health.

[11]  M. Kaplanoğlu,et al.  Does ovarian endometrioma affect the number of oocytes retrieved for in vitro fertilization? , 2012, Bratislavske lekarske listy.

[12]  T. Tulandi,et al.  Effects of ovarian endometrioma on embryo quality. , 2011, Fertility and sterility.

[13]  R. Angioli,et al.  Histologic analysis of specimens from laparoscopic endometrioma excision performed by different surgeons: does the surgeon matter? , 2011, Fertility and sterility.

[14]  Seang Tan,et al.  Effects of ovarian endometrioma on the number of oocytes retrieved for in vitro fertilization. , 2011, Fertility and sterility.

[15]  D. Ghosh,et al.  Aromatase inhibitors in recurrent ovarian endometriomas: report of five cases with literature review. , 2011, Fertility and sterility.

[16]  C. Farquhar,et al.  Interventions for women with endometrioma prior to assisted reproductive technology. , 2010, The Cochrane database of systematic reviews.

[17]  T. Tulandi,et al.  Effect of different types of ovarian cyst on antral follicle count. , 2010, Fertility and sterility.

[18]  G. Adamson,et al.  Endometriosis fertility index: the new, validated endometriosis staging system. , 2010, Fertility and sterility.

[19]  S. Ferrero,et al.  Prevalence of newly diagnosed endometriosis in women attending the general practitioner , 2010, International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics.

[20]  E. Sarıdoğan,et al.  Value of transvaginal ultrasound in assessing severity of pelvic endometriosis , 2010, Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology.

[21]  T. Enomoto,et al.  A retrospective analysis of ovarian endometriosis during pregnancy. , 2010, Fertility and sterility.

[22]  T. Murakami,et al.  Long‐term outcome, including pregnancy rate, recurrence rate and ovarian reserve, after laparoscopic laser ablation surgery in infertile women with endometrioma , 2010, The journal of obstetrics and gynaecology research.

[23]  M. Minasi,et al.  Unilateral ovarian endometriotic cysts do not impair follicles development, oocyte and embryo quality: report on eight controlled ovarian hyperstimulations and ICSI cycles. , 2010, Human reproduction.

[24]  P. Vercellini,et al.  Endometriotic ovarian cysts negatively affect the rate of spontaneous ovulation. , 2009, Human reproduction.

[25]  S. Kahraman,et al.  In vitro Fertilization in Normoresponder Patients with Endometriomas: Comparison with Basal Simple Ovarian Cysts , 2007, Gynecologic and Obstetric Investigation.

[26]  R. Angioli,et al.  Histologic analysis of endometriomas: what the surgeon needs to know. , 2007, Fertility and sterility.

[27]  M. Candiani,et al.  Postsurgical ovarian failure after laparoscopic excision of bilateral endometriomas. , 2006, American journal of obstetrics and gynecology.

[28]  S. Huffel,et al.  The use of ultrasound‐based ‘soft markers’ for the prediction of pelvic pathology in women with chronic pelvic pain—can we reduce the need for laparoscopy? , 2006, BJOG : an international journal of obstetrics and gynaecology.

[29]  S. Huffel,et al.  The use of ultrasound‐based ‘soft markers’ for the prediction of pelvic pathology in women with chronic pelvic pain—can we reduce the need for laparoscopy? , 2006, BJOG : an international journal of obstetrics and gynaecology.

[30]  Y. Taketani,et al.  Recurrence of ovarian endometrioma after laparoscopic excision. , 2002, Human reproduction.

[31]  H. Awaji,et al.  Impact of ovarian endometrioma on oocytes and pregnancy outcome in in vitro fertilization. , 2005, Fertility and sterility.

[32]  R. Angioli,et al.  Laparoscopic stripping of endometriomas: a randomized trial on different surgical techniques. Part II: pathological results. , 2005, Human reproduction.

[33]  M. Bazot,et al.  Sonography and MR imaging for the assessment of deep pelvic endometriosis. , 2005, Journal of minimally invasive gynecology.

[34]  N. Ragni,et al.  Lateral distribution of benign ovarian cysts , 2004, International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics.

[35]  R. Hart,et al.  Excisional surgery versus ablative surgery for ovarian endometriomata. , 2005, The Cochrane database of systematic reviews.

[36]  M. Busacca,et al.  Ovarian endometriosis: from pathogenesis to surgical treatment , 2003, Current opinion in obstetrics & gynecology.

[37]  N. Raine-Fenning,et al.  The interobserver reliability and validity of volume calculation from three‐dimensional ultrasound datasets in the in vitro setting , 2003, Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology.

[38]  C. Sutton,et al.  Recurrence of chocolate cysts after laparoscopic ablation. , 2002, The Journal of the American Association of Gynecologic Laparoscopists.

[39]  P. Vercellini,et al.  Lateral distribution of recurrent ovarian endometriotic cysts. , 2002, Fertility and sterility.

[40]  F. Ghezzi,et al.  Recurrence of ovarian endometriosis and anatomical location of the primary lesion. , 2001, Fertility and sterility.

[41]  E. Kujansuu,et al.  In vitro fertilization in patients with ovarian endometriomas , 2000, Acta obstetricia et gynecologica Scandinavica.

[42]  D. Redwine.  Ovarian endometriosis: a marker for more extensive pelvic and intestinal disease. , 1999, Fertility and sterility.

[43]  S. Guerriero,et al.  Transvaginal ultrasonography in the diagnosis of pelvic adhesions. , 1997, Human reproduction.

[44]  W. Dmowski,et al.  Decrease in the size of ovarian endometriomas during ovarian suppression in stage IV endometriosis. Role of preoperative medical treatment. , 1996, The Journal of reproductive medicine.

[45]  A. Paoletti,et al.  The efficiency of transvaginal ultrasonography in the diagnosis of endometrioma. , 1993, Fertility and sterility.

[46]  E. Zupi,et al.  Ovarian cortex surrounding benign neoplasms: a histologic study. , 1993, American journal of obstetrics and gynecology.

[47]  J. Donnez,et al.  Administration of nasal Buserelin as compared with subcutaneous Buserelin implant for endometriosis. , 1989, Fertility and sterility.

[48]  D. Olive,et al.  Endometriosis: Pathogenetic Implications of the Anatomic Distribution , 1986, Obstetrics and gynecology.