Surgery versus conservative management of endometriomas in subfertile women: A systematic review

Jacob Brink Laursen, Jeppe Bennekou Schroll, Kirsten T Macklon, Martin Rudnicki

Publikation: Bidrag til tidsskriftReviewForskningpeer review

Resumé

INTRODUCTION: Endometriomas are present in up to 44% of all women with endometriosis and have a detrimental effect on fertility. However, it is controversial whether endometriomas should be surgically removed before assisted reproduction technology (ART). Our purpose was to evaluate whether surgical stripping of endometriomas in subfertile women improves the chance of a live birth. Secondary outcomes were impact on ovarian reserve and pain. Material and methods We conducted a systematic review and metaanalysis with results reported in accordance to the PRISMA guidelines. Summary of findings table was developed using GRADE. We searched Medline and Embase. Two reviewers performed the screening.

RESULTS: Out of 686 manuscripts we included one randomized controlled trial and nine retrospective cohort studies most of low quality. Odds ratio for live birth after surgery (compared with conservative management before in vitro fertilization (IVF)/ intracytoplasmic sperm injection (ICSI)) was 0.87 (95% CI; 0.64-1.18, six studies, I(2) = 3%; ⨁◯◯◯, VERY LOW quality). The mean difference of antral follicle count was -2.09 (95% CI; -4.84 - +0.67, four studies). No difference was observed regarding antral follicle count between the two groups (MD -2.09, 95% CI -4.84 to +0.67, four studies, ⨁◯◯◯, VERY LOW quality). Pain outcome was not reported in the included studies.

CONCLUSION: Very low quality evidence suggests no difference in odds ratio of live birth between women who underwent surgery for endometriomas before IVF/ICSI compared to conservative management. Further high quality studies are needed, but due to lack of convincing evidence favoring surgery we recommend considering conservative treatment if the only indication is subfertility. This article is protected by copyright. All rights reserved.

OriginalsprogEngelsk
TidsskriftActa Obstetricia et Gynecologica Scandinavica
Vol/bind96
Sider (fra-til)727–735
ISSN0001-6349
DOI
StatusUdgivet - 2017

Fingeraftryk

Endometriosis
Live Birth
Intracytoplasmic Sperm Injections
Odds Ratio
Manuscripts
Infertility
Cohort Studies
Randomized Controlled Trials
Retrospective Studies
Conservative Treatment
Guidelines

Citer dette

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title = "Surgery versus conservative management of endometriomas in subfertile women: A systematic review",
abstract = "INTRODUCTION: Endometriomas are present in up to 44{\%} of all women with endometriosis and have a detrimental effect on fertility. However, it is controversial whether endometriomas should be surgically removed before assisted reproduction technology (ART). Our purpose was to evaluate whether surgical stripping of endometriomas in subfertile women improves the chance of a live birth. Secondary outcomes were impact on ovarian reserve and pain. Material and methods We conducted a systematic review and metaanalysis with results reported in accordance to the PRISMA guidelines. Summary of findings table was developed using GRADE. We searched Medline and Embase. Two reviewers performed the screening.RESULTS: Out of 686 manuscripts we included one randomized controlled trial and nine retrospective cohort studies most of low quality. Odds ratio for live birth after surgery (compared with conservative management before in vitro fertilization (IVF)/ intracytoplasmic sperm injection (ICSI)) was 0.87 (95{\%} CI; 0.64-1.18, six studies, I(2) = 3{\%}; ⨁◯◯◯, VERY LOW quality). The mean difference of antral follicle count was -2.09 (95{\%} CI; -4.84 - +0.67, four studies). No difference was observed regarding antral follicle count between the two groups (MD -2.09, 95{\%} CI -4.84 to +0.67, four studies, ⨁◯◯◯, VERY LOW quality). Pain outcome was not reported in the included studies.CONCLUSION: Very low quality evidence suggests no difference in odds ratio of live birth between women who underwent surgery for endometriomas before IVF/ICSI compared to conservative management. Further high quality studies are needed, but due to lack of convincing evidence favoring surgery we recommend considering conservative treatment if the only indication is subfertility. This article is protected by copyright. All rights reserved.",
keywords = "Journal Article",
author = "{Brink Laursen}, Jacob and Schroll, {Jeppe Bennekou} and Macklon, {Kirsten T} and Martin Rudnicki",
note = "This article is protected by copyright. All rights reserved.",
year = "2017",
doi = "10.1111/aogs.13154",
language = "English",
volume = "96",
pages = "727–735",
journal = "Acta Obstetricia et Gynecologica Scandinavica",
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Surgery versus conservative management of endometriomas in subfertile women : A systematic review. / Brink Laursen, Jacob; Schroll, Jeppe Bennekou; Macklon, Kirsten T; Rudnicki, Martin.

I: Acta Obstetricia et Gynecologica Scandinavica, Bind 96, 2017, s. 727–735.

Publikation: Bidrag til tidsskriftReviewForskningpeer review

TY - JOUR

T1 - Surgery versus conservative management of endometriomas in subfertile women

T2 - A systematic review

AU - Brink Laursen, Jacob

AU - Schroll, Jeppe Bennekou

AU - Macklon, Kirsten T

AU - Rudnicki, Martin

N1 - This article is protected by copyright. All rights reserved.

PY - 2017

Y1 - 2017

N2 - INTRODUCTION: Endometriomas are present in up to 44% of all women with endometriosis and have a detrimental effect on fertility. However, it is controversial whether endometriomas should be surgically removed before assisted reproduction technology (ART). Our purpose was to evaluate whether surgical stripping of endometriomas in subfertile women improves the chance of a live birth. Secondary outcomes were impact on ovarian reserve and pain. Material and methods We conducted a systematic review and metaanalysis with results reported in accordance to the PRISMA guidelines. Summary of findings table was developed using GRADE. We searched Medline and Embase. Two reviewers performed the screening.RESULTS: Out of 686 manuscripts we included one randomized controlled trial and nine retrospective cohort studies most of low quality. Odds ratio for live birth after surgery (compared with conservative management before in vitro fertilization (IVF)/ intracytoplasmic sperm injection (ICSI)) was 0.87 (95% CI; 0.64-1.18, six studies, I(2) = 3%; ⨁◯◯◯, VERY LOW quality). The mean difference of antral follicle count was -2.09 (95% CI; -4.84 - +0.67, four studies). No difference was observed regarding antral follicle count between the two groups (MD -2.09, 95% CI -4.84 to +0.67, four studies, ⨁◯◯◯, VERY LOW quality). Pain outcome was not reported in the included studies.CONCLUSION: Very low quality evidence suggests no difference in odds ratio of live birth between women who underwent surgery for endometriomas before IVF/ICSI compared to conservative management. Further high quality studies are needed, but due to lack of convincing evidence favoring surgery we recommend considering conservative treatment if the only indication is subfertility. This article is protected by copyright. All rights reserved.

AB - INTRODUCTION: Endometriomas are present in up to 44% of all women with endometriosis and have a detrimental effect on fertility. However, it is controversial whether endometriomas should be surgically removed before assisted reproduction technology (ART). Our purpose was to evaluate whether surgical stripping of endometriomas in subfertile women improves the chance of a live birth. Secondary outcomes were impact on ovarian reserve and pain. Material and methods We conducted a systematic review and metaanalysis with results reported in accordance to the PRISMA guidelines. Summary of findings table was developed using GRADE. We searched Medline and Embase. Two reviewers performed the screening.RESULTS: Out of 686 manuscripts we included one randomized controlled trial and nine retrospective cohort studies most of low quality. Odds ratio for live birth after surgery (compared with conservative management before in vitro fertilization (IVF)/ intracytoplasmic sperm injection (ICSI)) was 0.87 (95% CI; 0.64-1.18, six studies, I(2) = 3%; ⨁◯◯◯, VERY LOW quality). The mean difference of antral follicle count was -2.09 (95% CI; -4.84 - +0.67, four studies). No difference was observed regarding antral follicle count between the two groups (MD -2.09, 95% CI -4.84 to +0.67, four studies, ⨁◯◯◯, VERY LOW quality). Pain outcome was not reported in the included studies.CONCLUSION: Very low quality evidence suggests no difference in odds ratio of live birth between women who underwent surgery for endometriomas before IVF/ICSI compared to conservative management. Further high quality studies are needed, but due to lack of convincing evidence favoring surgery we recommend considering conservative treatment if the only indication is subfertility. This article is protected by copyright. All rights reserved.

KW - Journal Article

U2 - 10.1111/aogs.13154

DO - 10.1111/aogs.13154

M3 - Review

C2 - 28421599

VL - 96

SP - 727

EP - 735

JO - Acta Obstetricia et Gynecologica Scandinavica

JF - Acta Obstetricia et Gynecologica Scandinavica

SN - 0001-6349

ER -