Management of endometriomas in women requiring IVF: to touch or not to touch

Juan A Garcia-Velasco, Juan A. García-Velasco, Edgardo Somigliana
Human Reproduction · 2008 · vol. 24(3) , pp. 496–501 · doi:10.1093/humrep/den398 · PMID:19056774 · W2022107013
article OA: closed CC0 ⤵ 200 in-corpus citations
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⚙ AI-generated summary by claude@2026-06, 2026-06-08 ⓘ

This paper questions the necessity of surgically removing ovarian endometriomas before IVF, recommending direct IVF to reduce costs and complications while reserving surgery for large cysts, pain, or suspected malignancy.

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Abstract

The classic, unproven dogma that ovarian endometrioma should be removed in all infertile women prior to IVF has been recently questioned. There is currently insufficient data to clarify whether the endometrioma-related damage to ovarian responsiveness precedes or follows surgery. Both endometrioma-related injury and surgery-mediated damage may be claimed to be involved and the relative importance of these two insults remains to be clarified. Convincing evidence has emerged showing that responsiveness to gonadotrophins after ovarian cystectomy is reduced. Conversely, the impact of surgery on pregnancy rates is unclear since no deleterious effect has been reported. Of relevance here is that surgery exposes women to risk related to a demanding procedure whereas risks associated with expectant management are mostly anecdotal or of doubtful clinical relevance. We recommend proceeding directly to IVF to reduce time to pregnancy, to avoid potential surgical complications and to limit patient costs. Surgery should be envisaged only in presence of large cysts (balancing the threshold to operate with the cyst location within the ovary), or to treat concomitant pain symptoms which are refractory to medical treatments, or when malignancy cannot reliably be ruled out.

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Condition tags

mesh:D004715endometrioma

MeSH descriptors

Endometriosis Fertilization in Vitro Cysts Cysts Endometriosis Female Fertilization in Vitro Gonadotropins Gonadotropins Humans Infertility, Female Infertility, Female Ovarian Diseases Ovarian Diseases Ovary Ovary Pregnancy Pregnancy Outcome Reproductive Techniques, Assisted Treatment Outcome

Citation neighborhood

Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. [ expand to 2 hops ] — adds papers reached through this work's immediate citers/citees. Heavier; up to 60 extra dots.

References (61)

Cited by (50)

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