Does surgery for ovarian endometriomas improve fertility?
['CONCLUSION: Endometriomas per se appear to be the main cause of the reduced long-term reproductive performance of the affected patients, with little or no contribution from surgery. Furthermore, endometrioma surgery seems to improve the success rates of fertility treatment.', 'Amongst the 38 women desiring pregnancy after endometrioma surgery, 19 (50%) achieved a spontaneous pregnancy during the follow-up period. ', 'Of 33 women who wished to conceive, 67% became pregnant, spontaneously in 59%', 'CONCLUSIONS: Recurrence and pregnancy rates are encouraging in that they seem comparable to the best reported results after endometrioma cystectomy. ', 'While laparoscopic excision is known to improve fertility, recurrence can cause significant ovarian damage and adverse affects on fertility.', 'Surgery is considered to play a role within the framework of the therapeutic options to cure infertile women with the disease even though its effectiveness is generally modest. ', 'Randomized controlled trials showed that the excision technique is associated with a higher pregnancy rate and a lower rate of recurrence although it may determine severe injury to the ovarian reserve. ', 'Surgical treatment is associated with a high recurrence rate and its employment for women undergoing assisted conception has recently been challenged.', 'Laparoscopic excision of ovarian endometrioma prior to IVF does not offer any additional benefit over expectant management. ', 'For those women subsequently attempting to conceive it was also associated with a subsequent increased spontaneous pregnancy rate in women who had documented prior sub-fertility (OR 5.21 CI 2.04-13.29).', 'here is insufficient evidence to favour excisional surgery over ablative surgery with respect to the chance of pregnancy after controlled ovarian stimulation and intra-uterine insemination (OR 1.40 CI 0.47-4.15) . ', 'CONCLUSIONS: These findings suggest that in a context of more than one year infertility only related to endometriosis, it is reasonable to offer these patients a complete operative laparoscopic treatment of their lesions, which enables 65% of them to be pregnant within a 8.5 months post-surgical median time to pregnancy and spontaneously in 60%. ', " It was also associated with a subsequent increased rate of spontaneous pregnancy women who had documented prior sub-fertility (OR 5.21 CI 2.04-13.29). AUTHORS' CONCLUSIONS: There is some evidence that excisional surgery for endometriomata provides for a more favourable outcome than drainage and ablation, with regard to the recurrence of the endometrioma, recurrence of symptoms and subsequent spontaneous pregnancy in women who were previously subfertile. ", 'Surgery is an option for treatment, but there is no convincing evidence that it promotes a significant improvement in fertility.', 'In conclusion, ovarian surgery for the treatment of endometriosis reduces the ovarian outcome in IVF/ICSI cycles in women >35 years old, and might also decrease pregnancy rates. ', 'Improvement of pain symptoms occurred in 87% of the patients and fertility rate was 45%.', 'The long-term results, especially the fertility outcome, have been promising: 12 of 20 women (60%) achieved a term pregnancy following a laparoscopic endometrioma procedure alone. ', 'Among this group, 115 patients (54%) conceived following surgery; of these conceptions, 109 resulted in a living child.', 'WIDER IMPLICATIONS OF THE FINDINGS: Despite the available evidence that surgery for endometriomas does not improve the outcome of ART and may damage ovarian reserve, it seems that the majority of gynaecologists in the UK offer ovarian cystectomy to their patients.', 'Ovarian endometriomas does not exclude fertility.', 'Removal of endometriomas before in vitro fertilization does not improve fertility outcomes: a matched, case-control study.', 'Conclusion(s): Laparoscopic cystectomy for endometriomas before commencing an IVF cycle does not improve fertility outcomes.', 'Despite the available evidence that surgery for endometriomas does not improve the outcome of ART and may damage ovarian reserve, it seems that the majority of gynaecologists in the UK offer ovarian cystectomy to their patients.', 'Furthermore, laparoscopic removal of endometriomas does not improve IVF results, but may cause a decrease of ovarian responsiveness to gonadotropins.', 'Furthermore, endometrioma surgery seems to improve the success rates of fertility treatment.', 'Laparoscopic cystectomy for endometriomas before commencing an IVF cycle does not improve fertility outcomes']
['Yes, endometrioma surgery seems to improve the success rates of fertility treatment.']
['yes']