Should patients undergo endometrioma surgery before IVF/ICSI? a retrospective study with propensity score matching.

RESEARCH QUESTION: Does surgical management of ovarian endometriomas improve in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI)? DESIGN: This retrospective study analyzed 1,456 IVF/ICSI cycles from June 2017 to September 2022, comparing 530 control cycles with 926 endometriosis (EMS) cycles. The EMS group comprised pre-EMS (non-operated endometriomas, N = 272) and post-EMS (operated endometriomas, N = 654) subgroups. Propensity score matching (PSM) balanced female age, antral follicle count (AFC), body mass index (BMI), anti-Müllerian hormone (AMH), follicle stimulating hormone (FSH), and estradiol levels. Receiver operating characteristic (ROC) analyses identified potential predictors of high-quality D3 embryos and live birth. RESULTS: After PSM, the EMS group showed significantly lower normal fertilization rates, D3 embryo rates, and ovarian sensitivity index (OSI) compared to the control group (P < 0.05), but comparable oocyte yield, fertilization outcomes, and embryo parameters. Subgroup analysis showed that advanced-stage post-EMS cases had fewer retrieved oocytes and embryos, along with lower OSI, than the pre-EMS group after PSM. LBRs were similar between the EMS and control groups, irrespective of prior endometrioma surgery. ROC analysis identified AMH (cutoff 1.17 ng/mL; AUC 0.703, 95% CI 0.654-0.752) and AFC (cutoff 7.5; AUC 0.670, 95% CI 0.621-0.720) as predictors of high-quality day-3 embryos in EMS patients. In post-EMS patients, AMH (cutoff value 1.175; AUC 0.703, 95% CI 0.647-0.759) and AFC (cutoff 6.5; AUC 0.667, 95% CI 0.608-0.725) were predictive. AMH, AFC, age, and endometrioma size did not predict live birth. CONCLUSION: Advanced-stage Endometriosis negatively impacts oocyte quantity and ovarian response, but endometrioma surgery may not improve these outcomes or LBRs. Following exclusion of malignancy, asymptomatic endometriosis patients with AMH ≤ 1.17 ng/mL or AFC ≤ 7 should not routinely undergo cystectomy.