Journal Article Journal Article Epublish
PubMed: 39873421 DOI: 10.5935/1518-0557.20240090
The endometrioma paradox.
JBRA Assist Reprod 29(1):145-149
Authors: João Antonio Dias, Carlos Roberto Izzo, Georges Fassolas, Luiz Fernando de Oliveira Henrique, Gustavo Arantes Rosa Maciel, Sérgio Podgaec, Luciana Carvalho Delamuta
Affiliations
- Clínica Originare, Medicina Reprodutiva, São Paulo, Brazil.
- Hospital Israelita Albert Einstein, São Paulo, Brazil.
Abstract
Endometriosis is a chronic disease that affects around 10% of reproductive age women worldwide and a common cause of infertility. One of its manifestations is ovarian endometriomas, which are present in 17-44% of endometriosis patients. Endometriomas can impair fertility by mechanical stretching and local inflammation, promoting oxidative stress in the surrounding ovarian cortex that could lead to apoptosis and necrosis of early follicles. The removal of endometriomas may improve spontaneous pregnancy rates, as already demonstrated by some studies. To reduce endometriomas recurrence, it is advised to perform cystectomy followed by hormonal suppression. However, this approach is unfeasible in patients desiring pregnancy. At the same time, cystectomy poses a threat to ovarian reserve and, therefore, to controlled ovarian stimulation. Women who have endometriomas surgically removed are at risk to have diminished response to ovarian stimulation if in vitro fertilization is needed in the future.
MeSH
Pregnancy, Fertility, Reproductive Techniques, Assisted, Ovary, Infertility, Fertilization In Vitro, Cystectomy