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Treatment of endometrioma before in vitro fertilization (IVF) is challenging as it may affect ovarian response to induction. A systematic review to search for the available optimal management of ovarian endometrioma before ovulation induction in IVF. The optimal approach for treating endometrioma prior to IVF is not clear yet due to lack of well-designed randomized controlled trials.

Background: To introduce minimally invasive methods for the successful treatment of tubo-ovarian abscesses (TOAs), an antibiotic regimen was considered the first line of treatment. However, in some cases, this approach fails, and another intervention (laparotomy or minimally guidance drainage) is required. Case Presentations: 3 women with a history of long-time infertility, all of them were candidates for in vitro fertilization referred to the obstetrics and gynecology department with similar manifestations. For these 3 cases (30–40 yr) the first approach was a broad-spectrum antibiotic therapy. In 2 cases the last step in treatment was transvaginal ultrasound guidance drainage, and in one case laparotomy was done after antibiotic regimen failure; however, in all of 3 cases the best results were seen in transvaginal ultrasound guidance drainage. Conclusion: Patients who have ovarian endometrioma and undergo an assisted reproductive technology cycle, as well as ovum pick up, increase the possibility of TOA occurrence in them. The use of transvaginal ultrasound guidance drainage approach for the treatment of TOA in selective cases, in addition to broad-spectrum antibiotics in patients might reduce their need for invasive treatment with laparotomy.

Endometriosis is a major health concern in women who have it. Unfortunately, there is no definitive cure except panhysterectomy with its sequelae including induction of premature menopause due to loss of ovaries. Therefore, revealing the causes of this puzzling disease is necessary to avoid contracting it, and to spare women the health disorders resulting from it and the difficulties of treating it. We aimed to study endometriosis with a focus on its theoretical causes. Its classification reports and theories of pathogenesis were identified and studied from available database searches. The causes of endometriosis remain mysterious. Many theories have been proposed to explain the etiology, but retrograde menstruation (RM) remains the closest in this regard. Although this theory is the most accepted in the pathogenesis of endometriosis, its causes are still a matter of debate, especially in women who do not suffer from obstructions to menstrual outflows, such as cases of congenital cervical stenosis and imperforate hymen. It is suggested in some studies that there may be a relationship between women who engage in sexual activity during menstruation and the development of endometriosis. It is concluded that endometriosis is a painful and debilitating disease. Identifying its causes is essential to control the disease and avoid any burdens on health. RM is the main theory for its pathogenesis but its causes are still uncertain. Sexual activity during menstruation may be a possible cause of RM but needs more evidence. Future studies are recommended to reveal all aspects of the pathogenesis of endometriosis. Key words: Sexual behavior, Endometrioma, Menstruation, Retrograde, Painful, fertility.

Background Endometriosis remains one of the most challenging chronic conditions to treat in gynecology. This condition is further complicated when patients concomitantly present with a history of infertility even though many will eventually progress to treatment with in-vitro fertilization (IVF). However, endometriosis presents its own unique set of challenges when preparing a patient for and performing an IVF cycle. This is especially the case when endometriomas are present and contribute to the diagnosis of advanced stage endometriosis (revised ASRM classification system, stages III-IV). Main text In this review, we provide a summary of contemporary strategies to optimize IVF outcomes for patients with this systemic disease. Such strategies range from efforts and timing of such efforts to reduce disease burden via medical and surgical approaches, methods to optimize ovulation induction for maximizing egg/embryo yield as well as strategies to maximize success of implantation during embryo transfer. In addition, we delve into future strategies to reduce endometriosis disease burden which have the potential to improve IVF outcomes. Conclusion This review provides a contemporary approach to optimizing IVF outcomes in patients with endometriosis of various stages.

Background: Endometrioma, a common manifestation of endometriosis, often indicates the severity of the disease. In vitro fertilization and embryo transfer (ET) are key therapeutic strategies for infertility associated with endometriosis. However, the optimal type of ET (frozen or fresh) and its impact on pregnancy success rates remain debated, with limited studies available. Objective: This historical cohort study aimed to compare fertility and neonatal outcomes, focusing on live birth rate (LBR), clinical pregnancy, and implantation rates in women with endometrioma-associated infertility, between fresh and frozen embryo transfer (FET). Materials and Methods: In this historical cohort study, the medical records (files) of 289 women diagnosed with endometrioma-related infertility, who underwent in vitro fertilization/intracytoplasmic sperm injection treatment at Royan Institute, Tehran, Iran between March 2016–2021 were reviewed. Ultimately, 200 files that met the established criteria were selected for review. The extracted data was then compared between groups: FET (n = 121) and fresh ET (n = 79). Results: No significant differences were observed between the groups in terms of demographic characteristics and endometrioma size. The only significant difference in fertility outcomes was the LBR, which was 36.4% for the FET group compared to 22.8% for the fresh ET group (p = 0.04). No significant differences were observed in neonatal outcomes between the groups. Overall, our study suggests that FET may lead to higher LBRs in women diagnosed with endometrioma.  Conclusion: Our study suggests that FET may lead to higher LBRs in women diagnosed with endometrioma.

Objective The long-term impact of electrocoagulation and suture hemostasis on ovarian reserve (OR) after endometriotic cystectomy remains uncertain. This meta-analysis aimed to compare the short-term and long-term effects of coagulation and suture hemostasis on ovarian reserve based on the postoperative levels of the anti-Müllerian hormone (AMH). Methods PubMed, MEDLINE, EMBASE, Cochrane, and other databases were searched for eligible studies published up to May 2023.The quality assessment of the RCTs was performed as indicated by the Cochrane Collaboration tool in the Cochrane Handbook. The Newcastle–Ottawa Scale (NOS) was used to assess the quality of the non-RCTs. The random-effects or fixed-effects model was used to quantify the weighted mean difference (WMD) at the 95% confidence interval (CI) in the treatment effect across the different studies. Results Six randomized controlled trials and two prospective studies were included in this meta-analysis. The meta-analysis showed that there was a statistically significant difference in the AMH levels between the electrocoagulation and the suture group at 1 month (WMD: −0.52, 95%CI (−1.02, −0.01), P  = 0.04), 3 months (WMD: −0.72, 95%CI (−1.13, −0.31), P  = 0.0005), 6 months (WMD: −0.80, 95%CI (−1.22, −0.38), P  = 0.0002) and 12 months (WMD: −0.81, 95%CI (−1.24, −0.37), P  = 0.0003), postoperatively. The mean difference of AMH in electrocoagulation group at 1, 3, 6 and 12 months after surgery was −1.75; −1.37; −1.10; −0.92 respectively; meanwhile, in the suture group were −2.50; −2.46; −2.33; −2.24, respectively. Conclusion Compared with electrocoagulation, suture hemostasis has less impact on OR. Although the OR of two groups gradually recovered, electrocoagulation still caused more damage to AMH than suture at 12 months after surgery. Suturing could be a better choice after stripping ovarian endometriomas.

Purpose To investigate the clinical characteristics and prognosis of surgically treated ovarian endometrioma (OMA) in pregnant women. Methods This retrospective cohort study analyzed 30 patients with pathologically confirmed ovarian endometrioma during pregnancy and delivery. Clinical characteristics and follow-up data were summarized. Results Among the 30 patients, 21 underwent laparoscopic surgery during pregnancy. A total of 24 OMAs were identified in 21 patients and exhibited various changes during pregnancy: 13 did not show significant changes, 10 increased in size and 1 decreased in size. The indications for surgery included suspicion of malignancy (16/21), large and progressive growth (3/21), and ovarian cyst torsion (2/21). The postoperative pathology results showed that decidualization occurred in 7 cases, while only 1 case was diagnosed with malignancy, and there appears to be a lack of specific clinical characteristics to distinguish between malignant cysts and de ci du a l I zed cysts. Of the 21 patients, 19 underwent successful follow-up. Among them, 2 cases were preterm births, 1 experienced recurrence, and 2 developed adenomyosis during long-term follow-up. Besides, 9 patients underwent cystectomy during the cesarean section. All the ultrasound findings showed regular and smooth-walled unilocular cysts, with diameters smaller than 6 cm and no apparent growth during pregnancy. Postoperative pathology revealed decidualization in 3 cases, and 1 case experienced recurrence during follow-up. Conclusions OMA presents various changes during pregnancy and caution should also be taken for recurrence after delivery. Surgical intervention is prompted mainly by suspected malignancies which is difficult to distinguish with decidualization, and laparoscopic surgery is relatively safe during mid-pregnancy.

Advanced endometriosis is associated with a reduction of IVF success. Surgical damage to the ovarian reserve following the excision of endometriomas has been claimed as a critical factor in the explanation of this detrimental effect. However, it is generally inferred that other mechanisms might also hamper IVF success in affected women. They include diminished responsiveness to ovarian stimulation, altered steroidogenesis, a decline in oocyte quality, reduced fertilization and embryo development, and impaired implantation. To navigate these limitations, we scrutinized available literature for studies specifically designed to address distinct phases of the IVF process. Utmost consideration was given to intra-patient ovarian response comparisons in women with unilateral endometriomas and to studies applying a meticulous matching to control confounders. The following observations have been drawn: 1) endometriosis has a negligible impact on ovarian response. A slight reduction in stimulation response can only be observed for endometriomas larger than 4 cm. Follicular steroidogenesis is unaffected; 2) oocyte quality is not hampered. Fertilization rates are similar, and intracytoplasmic sperm injection (ICSI) is not justified. Embryonic development is uncompromised, with no increase in aneuploidy rate; 3) endometrial receptivity is either unaffected or only slightly impacted. In conclusion, our study suggests that, aside from the well-known negative effect on ovarian reserve from excisional endometrioma surgeries, endometriosis does not significantly affect IVF outcomes.

Objective To explore the risk factors for the recurrence of endometrioma and the risk factors for the recurrence of endometriosis-related pain after long-term follow-up. Methods This study retrospectively analyzed 358 women with endometriomas who had a minimum of 5-years follow up after laparoscopic endometrioma excision, which was performed at Peking Union Medical College Hospital from January 2009 to April 2013. All women were divided into recurrence group and nonrecurrence group. Analysis was performed with regard to preoperative history, laboratory analysis, findings during surgery, and symptoms during follow-up, including improvement and recurrence. Results The cumulative incidence rates of recurrence from 5 to 10 years after surgery were 15.4, 16.8, 19.3, 22.5, 22.5, and 22.5%, respectively. Significant differences were found between two groups in terms of age at surgery (RR: 0.764, 95% CI: 0.615–0.949, p  = 0.015), duration of dysmenorrhea (RR: 1.120, 95% CI: 1.054–1.190, p  < 0.001), presence of adenomyosis (RR: 1.629, 95% CI: 1.008–2.630, p  = 0.046), CA125 level (RR: 1.856, 95% CI: 1.072–3.214, p  = 0.021) and severity of dysmenorrhea. The severity of dysmenorrhea (RR: 1.711, 95% CI: 1.175–2.493, p  = 0.005) and postoperative pregnancy (RR: 0.649, 95% CI: 0.460–0.914, p  = 0.013) were significantly correlated with endometrioma recurrence in the multivariate analysis. No significant associations were found between the recurrence rate and gravida, parity, body mass index, infertility, leiomyoma presence, the size of ovarian endometrioma, the presence of deep infiltrating endometriosis, disease stage or postoperative medication. Conclusions The severity of dysmenorrhea and postoperative pregnancy were independent risk factors for the recurrence of ovarian endometriomas after surgery during the long-time follow up.

Laparoscopic surgery was originally considered the gold standard in the treatment of endometriosis-related infertility. Assisted reproductive technology (ART) was indicated as second-line treatment or in the case of male factor. The combined approach of surgery followed by ART proved to offer higher chances of pregnancy in infertile women with endometriosis. However, it was highlighted how pelvic surgery for endometriosis, especially in cases of ovarian endometriomas, could cause iatrogenic damage due to ovarian reserve loss, adhesion formation (scarring), and ischemic damage. Furthermore, in the last few years, the trend to delay the first childbirth, recent technological advances in ultrasound diagnosis, and technological progress in clinical and laboratory aspects of ART have certainly influenced the approach to infertility and endometriosis with, ART assuming a more relevant role. Management of endometriosis should take into account that the disease is chronic and involves the reproductive system. Consequently, treatment and counselling should aim to preserve the chances of pregnancy for the patient, even if it is not associated with infertility. This review will analyse the evolution of the management of infertility associated with endometriosis and propose an algorithm for treatment decision-making based on the most recent acquisitions.