Читать книгу Assisted Reproduction Techniques - Группа авторов - Страница 207

Challenge: The patient with an endometrioma.

Background:

 Occurs in around 5% of IVF patients.

 Reduces ovarian response to stimulation.

 IVF is commonly recommended, particularly if other infertility factors coexist.

 Surgical treatment before IVF does not increase pregnancy rate.

Management options:

 Diagnose endometriomas by transvaginal ultrasound scan.

 Establish outcomes of previous surgical and/or medical treatments.

 Check ovarian reserve (AMH, AFC).

 Evaluate access for oocyte retrieval.

 Recommend treatment with IVF and consider segmentation of the cycle.

 Consider laparoscopic excision for symptomatic patients with large (common thresholds for “large” is > 4 cm) endometriomas, no previous surgery, adequate ovarian reserve and difficult vaginal access to the ovaries for oocyte retrieval

 Avoid surgery in patients with previous history of surgeries and reduced ovarian reserve.

 If the cyst is large and surgical treatment is not planned, GnRH agonists pretreatment for at least 3 consecutive months before the IVF cycle may be considered.

 Avoid puncturing or draining the endometrioma during oocyte retrieval.

 Give intravenous antibiotics at oocyte retrieval.