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Copenhagen,
Denmark
19 - 22 June 2005
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The
effect of ovarian endometriomas on the ART
cycle outcome
T Gurgan [1], A Demirol [2], B Girgin [2]
[1] Hacettepe University Hospital
IVF
Ankara, Turkey
[2] CLINIC IVF Center
IVF
Ankara, Turkey
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Objective
To investigate the effect of conservative surgery
of ovarian endometriomas before an ICSI cycle.
Materials and methods
Ninety-nine patients with endometriomas who referred
to ICSI cycle were enrolled in the study. The patients
were prospectively randomized into two groups; the
patients in group I (49 patients) underwent conservative
ovarian surgery before ICSI cycle, and the patients
in group II (50 patients) directly underwent ICSI
cycle. The size of the endometrioma was >3 cm
and <6 cm. There was no difference according
to the mean age, basal FSH level, BMI, type of infertility
between the groups (all patients had male factor
and/or tubal factor infertility, but none of the
male partners were azoospermic).
The laparoscopic surgery for group I consisted of
dissection of the pseudocapsule of the endometrioma
from the underlying stroma by gentle traction and
countertraction in the right plane. Gentle bipolar
coagulation was performed to the ovarian stroma
when necessary. The stimulation was started 3 months
later than the operation in group I and directly
in group II. Leuprolide acetate (Lucrin, Abbot)
was started at the luteal phase. Rec-FSH (Gonal-F,
Serono) was administered in a step-down fashion,
starting with a 300 IU/day; and after 5 days, the
dose was adjusted.
HCG (Profasi, Serono) was administered when at least
two or three follicles reached a mean diameter of
16 mm. ICSI was performed for all M II oocytes and
ET was performed on day 3.
Results
In the ovarian surgery group, stimulation was significantly
longer (14 days in group I and 10.8 days in group
II), total rec-FSH dose was significantly higher
(4575 IU in group I and 3675 in group II), and mean
number of mature oocytes were significantly higher
(7.8 in group I and 8.6 in group II). There was
no difference in terms of fertilization (86% in
group I and 88% in group II), implantation (16.5%
in group I and 18.5% in group II), and pregnancy
rate (34% in group I and 38% in group II).
Conclusion
Ovarian surgery resulted in longer stimulation,
higher FSH requirement, lower oocyte number but
fertilization, pregnancy and implantation rates
did not differ between the groups.
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