- L Muzil, R Marana, et al (Rome, Italy)
Postoperative administration of monophasic combined oral contraceptives after laparoscopic treatment of ovarian endometriomas: A prospective, randomized trial
Am J Obstet Gynecol, 182, Sept.2000: 588-92
Objective : To evaluate the efficacy of postoperative administration of monophasic, combined, low-dose oral contraceptives on endometrioma recurrence and on persistence-recurrence of associated pain symptoms after laparoscopic treatment of moderate-to-severe endometriosis.
Study Design : In a prospective, randomized trial 70 patients who were not attempting to conceive, aged 20 to 35 years, underwent laparoscopic excision of ovarian endometriosis, followed by either postoperative administration of low-dose cyclic oral contraceptives for 6 months or no treatment on the basis of a computer-generated sequence. At 3 and 6 months after surgery and then at 6-month intervals, both groups underwent ultrasonographic examination for possible evidence of endometrioma recurrence and for evaluation of the absence, persistence, or recurrence of pain symptoms.
Results : Two patients in the oral contraceptive group did not complete the study. After a mean follow-up of 22 months (range, 12-48 months), there were 2 (6.1%) endometrioma recurrences in the 33 patients who received postoperative oral contraceptives versus 1 (2.9%) recurrence in the 35 patients in the control group (not significant). The moderate-to-severe pain recurrence rate was 9.1% in the oral contraceptive group versus 17.1% in the control group (not significant).
The mean time to recurrence of either symptoms or endometriomas was 18.2 months in the oral contraceptive group versus 12.7 months in the control group. The 12-month cumulative recurrence rate at life-table analysis was significantly lower for patients receiving oral contraceptives versus control subjects, whereas no significant difference was evident at 24 and 36 months.
Conclusion : Postoperative administration of low-dose cyclic oral contraceptives does not significantly affect the long-term recurrence rate of endometriosis after surgical treatment. A delay in recurrence is evident at life-table analysis.
- Jacques Donnez, Christine Wyns, et al
Does ovarian surgery for endometriomas impair the ovarian response to gonadotropin?
Fert. & Ster.76(4), Oct.2001,pg.662-665
Objective: To evaluate the ovarian response to stimulation conducted for IVF treatment in women who have undergone conservative surgery for endometriomas.
A series of 374 women who underwent in vitro fertilization (IVF). The study group consisted of patients with ovarian endometriomas who had undergone laparoscopic surgery in an attempt to become pregnant but had failed within a year of surgery. The control group consisted of 289 patients with tubal factor infertility.
Main Outcome Measures: Stimulation parameters, fertilization, implantation, and pregnancy rates were analysed in both groups.
Results : There was no significant difference between the two groups in stimulation parameters or IVF outcome.
Conclusions: A total of 820 cycles were analyzed. A similar IVF-ET outcome was observed in patients with endometriosis after ablation of endometriomas compared to women with tubal factors. In conclusion, endometrioma surgery by internal wall vaporization does not impair IVF outcome. The clinical pregnancy rate was respectively 37.4% and 34.6% in the endometriosis group and the control group.