Comparison of GnRH agonist administration before and after laparoscopic drainage of endometriomas

Our purpose was to assess the most proper time for initiation of gonadotropin-releasing hormone agonist (GnRH-a) therapy combined with laparoscopic drainage. The first group included 13 women with 18 endometriomas (5 bilaterally) in whom drainage of the endometrioma during initial laparoscopy was followed by ovarian suppression with GnRH-a therapy, The second group consisted of 12 women with 17 endometriomas. These patients received GnRH-a during the luteal phase of the cycle and underwent laparoscopic drainage after menstruation, Both groups recieved GnRH-a therapy for 6 months, and a second-look laparoscopy was performed to assess the results in all cases, Complete resolution was found in 33.3% of patients in the first group compared with 58.8% in the second group. Of the persistent cases, partial resolution (decrease in cyst size) was found in all cases in both groups, However, at 1-year follow-up, persistence of the endometriomas was found in 83.3% of group 1 and 52.9% of group 2, According to these findings, we conclude that drainage of endometrioma with perioperative GnRH-a therapy cannot be considered the treatment of choice, However, GnRH-a therapy initiated before laparoscopic drainage has better outcomes compared with GnRH-a suppression after laparoscopic drainage.