Management of endometrioma prior to IVF: compliance with ESHRE guidelines

Gelbaya, Tarek A.; Gordts, Stephan; D’Hooghe, Thomas M.; Gergolet, Marco; Nardo, Luciano G.

doi:10.1016/j.rbmo.2010.04.023

« Previous Next »Reproductive BioMedicine Online
Volume 21, Issue 3 , Pages 325-330, September 2010

Management of endometrioma prior to IVF: compliance with ESHRE guidelines☆

Received 17 January 2010; received in revised form 21 February 2010; accepted 13 April 2010. published online 02 August 2010.

Declaration: The authors report no financial or commercial conflicts of interest.

Abstract

Management of endometrioma before IVF remains controversial. As well as some measurable benefits from surgical treatment, there are also potential risks that should be discussed with the patients to help them make an informed decision. When surgery is compared with expectant management, there appear to be no statistically significant differences in pregnancy rate and ovarian response to exogenous stimulation. The objectives of this European Society of Human Reproduction and Embryology (ESHRE)-sponsored survey were to acquire knowledge of current strategies for the management of endometrioma (>3cm) prior to IVF and to explore adherence to ESHRE guidelines. A validated, peer-reviewed online questionnaire made of 14 questions was sent to 396 members of the ESHRE Special Interest Groups (Reproductive Surgery and Endometriosis/Endometrium), with a response rate of 27%. Surgical management is the most common treatment (82.2%), with drainage and excision of the cyst wall being the preferred surgical approach (78.5%). Monthly depot gonadotrophin-releasing hormone analogues are the preferred choice of medical treatment of endometriomas before IVF, with an average duration of treatment of 3months. The findings demonstrate that surgery remains the commonest treatment offered for women with endometrioma before IVF. This is in line with the recommendations of the ESHRE guidelines.

Keywords: assisted reproduction, endometrioma, ESHRE, management, surgery

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☆ Luciano G Nardo is a consultant in gynaecology, reproductive medicine and surgery at St Mary’s Hospital, Manchester, and honorary lecturer at the University of Manchester, UK. He is director of North West Fertility. He is an Royal College of Obstetricans and Gynaecologists-accredited subspecialist in reproductive medicine and surgery, and has clinical interests in endometriosis, infertility, assisted conception, gynaecological endocrinology and minimal access gynaecological surgery. He is an associate member of many international learned societies. Luciano serves on the executive committee of the British Fertility Society (BFS) and is chair of the BFS Training Subcommittee. He has an active research programme both in the UK and abroad focusing on polycystic ovary syndrome, endometriosis, ovarian reserve, novel approaches to ovarian stimulation and mechanisms of embryo implantation. He has published in excess of 70 papers on many aspects of gynaecology, reproductive medicine and surgery and has written numerous textbook chapters and journal supplements. He is member of the editorial board of the peer-reviewed journal Reproductive Biomedicine Online and a member of the advisory board of IVF News.Direct! Luciano is an advisor for international professional and patients’ organizations, and is ad-hoc referee of many scientific journals in the field.