Optimizing infertility treatment for ovarian endometrioma: is surgical intervention preferable before or after in-vitro fertilization programs?

PurposeEndometriosis is one of the common endometrial pathologies that occurs in reproductive-age women and could lead to infertility. This study set out to observe which clinical management of endometriosis with endometrioma is prominent in improving IVF outcomes. Materials and methodsThis was a retrospective cross-sectional controlled study at Bunda General Hospital and Morula IVF Jakarta Clinic, Indonesia from Jan 2018 to Dec 2022. A total of 279 patients diagnosed with endometriosis were recorded. Of that, 86 couples with endometrioma underwent an in vitro fertilization program (IVF). Forty-eight women performed IVF prior to the removal of endometrioma through surgery (IVF-OPS) while the remaining underwent surgery for endometrioma removal followed by an IVF program (OPS-IVF). Each group was compared to the control group which was administered to an IVF program without the removal of endometriosis. The primary outcome was the clinical pregnancy rate. Mann-Whitney or Kruskal-Wallis and Chi square were used for statistical analysis. A p value of < 0.05 was considered statistically significant. ResultsA comparable clinical pregnancy rate was observed across the three groups (p = 0.068). Nonetheless, the IVF-OPS approach led to an improved number of top-quality blastocysts compared to both the control and OPS-IVF groups (p < 0.05). Eventually, IVF-OPS was shown to be a prominent approach for endometriosis with endometrioma management in comparison to OPS-IVF in terms of clinical pregnancy rate as well as embryology laboratory outcomes (p < 0.05). ConclusionOur result suggested that intervention of endometriosis with removal surgery was superior when performed after the IVF program.