Ovarian endometriosis and infertility: in vitro fertilization (IVF) or surgery as the first approach?
Volume 110, Issue 7, Pages 1218–1226
Bruce A. Lessey, M.D., Ph.D., Stephan Gordts, M.D., Olivier Donnez, M.D., Ph.D., Edgardo Somigliana, M.D., Ph.D., Charles Chapron, M.D., Juan A. Garcia-Velasco, M.D., Jacques Donnez, M.D., Ph.D.
Prosurgery: surgery should be the first approach for ovarian endometriosis and infertility
IVF is commonly applied to all indications for infertility, but increasingly unexplained causes predominate (www.sart.org). Specifically, endometriosis is listed as the primary diagnosis in less than 4% of cases in the United States, primarily because laparoscopy is not performed for the basic infertility workup, as it once was (1). Unexplained cases of infertility show a high prevalence of endometriosis (2, 3). Visible endometriosis such as endometriomas present a special challenge, especially since ovarian reserve may be compromised when ovarian surgery is performed.
Pro-IVF: IVF should be the first approach for ovarian endometriosis and infertility
Informative randomized controlled trials on the comparison between surgery and IVF for infertile women carrying ovarian endometriomas are lacking, and available guidelines are contradictory (43). Moreover, from the patient perspective, these two management strategies are extremely different and involve several clinical and personal aspects that are beyond the mere pregnancy rate. One may even wonder whether randomized controlled trials will ever provide a satisfactory answer to the question (44). Therefore, a shared and informed decision with the patient is mandatory, and, to be balanced, this requires in-depth and transparent information in a multidisciplinary context that can offer both surgery and IVF.