Could laparoscopic cystectomy improve intrauterine insemination with controlled ovarian hyperstimulation outcomes in women with endometrioma?

Objectives: To clarify the effects of laparoscopic cystectomy of endometriomas on intrauterine insemination with controlled ovarian hyperstimulation (COH + IUI) success in women with the disease. Material and methods: We performed a retrospective study with endometrioma patients having at least one patent fallopian tube. The study group consisted of 57 infertile patients with a history of laparoscopic cystectomy who underwent 83 COH + IUI cycles. The control group consisted of 88 patients with endometrioma who underwent 161 COH + IUI cycles without surgery.Results: The total number of antral follicles was significantly lower in the study group than in the control group (10.1 +/- 5.1 vs 11.9 +/- 5.0; p = 0.008). No significant difference was observed in the clinical pregnancy and live birth rates per cycle [(9.6% vs 7.6%; p=0.7175 OR: 1.195% CI: 0.6-2.1) and (7.2% vs 6.2%; p = 0.9544 OR: 1.1 95% CI: 0.5-2.1], respectively) between the operated and non-operated groups. Conclusions: The results of the study show that the presence of an endometrioma with at least one patent fallopian tube does not require any cystectomy before COH+IUI treatment because no improvement was observed in the treatment outcomes of the patients who underwent preceding surgery. We conclude that an operation may be taken into consideration when malignancy cannot be ruled out or severe pelvic pain related to endometrioma cannot be relieved.