Endometriotic ovarian cysts (known as endometriomas) can be found in up to 17–44% of women with endometriosis and are often associated with the severe form of the disease.
The presence of an endometrioma can often present a clinical dilemma during the course of fertility treatment. For example, there can be uncertainty regarding the decision to operate or to manage conservatively, balancing the potential detrimental effect of surgery on the ovarian reserve against the potential benefit that may be gained.
Current guidelines often rely on the evidence from either small and/or retrospective controlled studies. In particular, for assisted reproductive treatment some of the referenced studies were conducted in the 1980s and 1990s. Since then, in vitro fertilisation success rates have significantly improved due to changes in stimulation protocols and available drugs, as well as the introduction of laboratory techniques such as intracytoplasmic sperm injection and blastocyst culture.
This Scientific Impact Paper will review the current evidence for management of endometriomas within the context of infertility treatment.
Declaration of interests (guideline developers)
Dr K Jayaprakasan MRCOG, Derby: None declared.
Professor C Becker, Associate Professor, Nuffield Department of Obstetrics and Gynaecology, University of Oxford: Chair of the European Society of Human Reproduction and Embryology (ESHRE) Endometriosis Guideline Development Group, and Medical Advisory Committee Member for Endometriosis UK. Professor Becker was also an Independent Data Monitoring Committee Member for a phase II clinical study sponsored by ObsEva.
Dr M Mittal MRCOG, Oxford: None declared.