DOES SIZE MATTER? THE ROLE OF OVARIAN ENDOMETRIOMAS IN AFFECTING OVARIAN FUNCTION AND ICSI OUTCOMES

Objective

The aim of this study was to evaluate the impact of ovarian endometrioma,particularly its size and bilaterality,on ICSI outcomes.The study sought to determine how endometriomas affect ovarian reserve,ovarian stimulation responses,embryo quality and reproductive outcomes in patients undergoing assisted reproductive technology(ART) due to endometriosis.

Materials and Methods

This retrospective cohort study analyzed data from ARTcycles performed at Uludağ University ART Center between January2011 and December2024.A total of 460 patients undergoing their first ICSI cycles were included. The study group consisted of 230 patients diagnosed with endometrioma. The control group included 230 patients with unexplained infertility,matched by age,AMH,and AFC using propensity score matching. Patients were classified into five groups:four based on endometrioma size,categorized into percentiles(0-25,25-50,50-75,75-100),and control group of women with unexplained infertility. Comparative assessments were made across the five groups regarding baseline characteristics,basal hormonal parameters,ovarian stimulation profiles. Embryological development parameters and clinical outcomes were analyzed to evaluate differences among the groups. The primary outcome measure was the implantation rate.

Results

When endometrioma size was categorized into percentiles,Group1 included those with a size≤2.5 cm(n=66),Group2 with a size>2.5–≤4 cm(n=48),Group3 with a size>4–≤6 cm(n=64),and Group4 with a size>6 cm(n=52).Apart from the increase in basal FSH values(p<0.001) corresponding to the size of the endometrioma, no significant differences were observed in other basal hormone parameters, antral follicle count(AFC)(p=0.171),or AMH levels(p=0.273).Additionally,the Follicular Output Rate (FOI)(p=0.454) and Follicular Output Rate Test(FORT)values(p=0.712),which assess ovarian response, were similar across all groups, including the control group. Compared to the control group, the presence of endometriomas was associated with a reduction in the number of oocytes(p<0.001) and blastocyst count(p=0.003) after OPU, while blastocyst formation(p=0.491) and implantation rates(p=0.472)remained unaffected. Although the increase in endometrioma size negatively impacted embryological parameters, it didn't alter the clinical outcomes(p=0.541).

Discussion

This study demonstrates that ovarian endometriomas reduce the number of oocytes and blastocysts retrieved,suggesting a potential negative impact of increased endometrioma size on ovarian function.Implantation rates were comparable between women with endometriomas and those with unexplained infertility.

Conclusion

Our study didn't observe significant differences in embryo quality or clinical pregnancy rates in the presence of endometriomas,indicating that the impact of endometriomas on these outcomes is likely limited.Further research is necessary to develop management strategies for endometriomas in ART cycles and to assess long-term outcomes.