In vitro fertilization outcome in women with unoperated bilateral endometriomas

Objective: To evaluate IVF outcome in women with unoperated bilateral endometriomas. Design: Multicenter retrospective cohort study. Settings: Two infertility units. Patient(s): Thirty-nine women with bilateral endometriomas matched with 78 unexposed control subjects. Intervention(s): Analysis of data from patients who underwent in vitro fertilization (IVF)-intracytoplasmic sperm injection. Main Outcome Measure(s): Ovarian responsiveness and oocyte quality. Result(s): Responsiveness to ovarian hyperstimulation was significantly reduced in women with bilateral endometriomas. The total numbers of developing follicles in case and control subjects were 9.6 ± 3.3 and 14.1 ± 6.8, respectively. The numbers of oocytes retrieved were 7.1 ± 3.2 and 9.8 ± 5.5, respectively. Conversely, oocyte retrieval was not hampered by the presence of the ovarian endometriomas. The rates (interquartile range) of oocytes retrieved per total number of developing follicles in case and control subjects were 77% (57%-88%) and 71% (63%-79%), respectively. Moreover, the quality of the retrieved oocytes did not differ. The fertilization rates (IQR) were 67% (56%-100%) and 70% (57%-100%), respectively. The rates (IQR) of top quality embryos per oocyte used were 33% (25%-50%) and 33% (20%-43%), respectively. The implantation rates were 22% and 23%, respectively. The clinical pregnancy rate and the delivery rate also did not differ. Conclusion(s): Although the presence of bilateral endometriomas at the time of IVF affects responsiveness to hyperstimulation, the quality of the oocytes retrieved and the chances of pregnancy are not affected.