Apostolos Kaponis1, Fuminori Taniguchi2, Yukihiro Azuma3, Imari Deura4, Charalampos Vitsas5, George O Decavalas6, Tasuku Harada7. 1. Associate Professor, Department of Obstetrics and Gynecology, Patras University School of Medicine, Patra, Greece. 2. Associate Professor, Department of Obstetrics and Gynecology, Tottori University Faculty of Medicine, Yonago, Japan. 3. Postgraduate Student, Department of Obstetrics and Gynecology, Tottori University Faculty of Medicine, Yonago, Japan. 4. Assistant Professor, Department of Obstetrics and Gynecology, Tottori University Faculty of Medicine, Yonago, Japan. 5. Resident, Department of Obstetrics and Gynecology, Patras University School of Medicine, Patra, Greece. 6. Professor, Department of Obstetrics and Gynecology, Patras University School of Medicine, Patra, Greece. 7. Professor, Department of Obstetrics and Gynecology, Tottori University Faculty of Medicine, Yonago, Japan.
Abstract
IMPORTANCE: Ovarian endometrioma is the most common form of endometriosis. Laparoscopy is frequently chosen for its treatment because medical treatment alone is inadequate. However, the role of laparoscopic treatment of ovarian endometriomas has been challenged by evidence questioning the benefits of surgery, especially in cases of young or infertile women. Other therapeutic modalities include expectant management, medical therapy, and, in cases of infertility, ovulation induction and assisted reproductive technology. None of these treatments offer cure of endometriosis. OBJECTIVE: The objective of this study was to present data concerning the current management of endometrioma. Benefits and complications after treatment and the impact on in vitro fertilization outcome are also highlighted. EVIDENCE ACQUISITION: An extensive literature search (PubMed) and Cochrane Library review up to December 2013 were performed using the following keywords: "endometrioma," "cystectomy," "infertility," "IVF," "malignant transformation," "management," and "recurrence." RESULTS: There is a lack of data from randomized trials to inform the optimal management of endometriomas with respect to pain relief, recurrence, and fertility. CONCLUSIONS AND RELEVANCE: Further studies are needed to determine the optimal management of endometrioma. Currently, there is no evidence that surgical management improves the fertility of women with endometrioma.
IMPORTANCE: Ovarian endometrioma is the most common form of endometriosis. Laparoscopy is frequently chosen for its treatment because medical treatment alone is inadequate. However, the role of laparoscopic treatment of ovarian endometriomas has been challenged by evidence questioning the benefits of surgery, especially in cases of young or infertile women. Other therapeutic modalities include expectant management, medical therapy, and, in cases of infertility, ovulation induction and assisted reproductive technology. None of these treatments offer cure of endometriosis. OBJECTIVE: The objective of this study was to present data concerning the current management of endometrioma. Benefits and complications after treatment and the impact on in vitro fertilization outcome are also highlighted. EVIDENCE ACQUISITION: An extensive literature search (PubMed) and Cochrane Library review up to December 2013 were performed using the following keywords: "endometrioma," "cystectomy," "infertility," "IVF," "malignant transformation," "management," and "recurrence." RESULTS: There is a lack of data from randomized trials to inform the optimal management of endometriomas with respect to pain relief, recurrence, and fertility. CONCLUSIONS AND RELEVANCE: Further studies are needed to determine the optimal management of endometrioma. Currently, there is no evidence that surgical management improves the fertility of women with endometrioma.