Evaluation of the Laparoscopic Cystectomy for Endometrioma in Women of the Reproductive Age


  • Sule Atalay Mert Etlik Zübeyde Hanım Obstetrics and Gynecology Training and Research Hospital, Health of Sciences University, Department of Reproductive Endocrinology and IVF, Ankara, Turkey
  • Berna Dilbaz Etlik Zubeyde Hanim Training and Research Hospital, Ankara, Turkey
  • Caner Kose Etlik Zubeyde Hanim Training and Research Hospital, Ankara, Turkey
  • Yaprak Engin Ustun Etlik Zubeyde Hanim Training and Research Hospital, Ankara, Turkey




Aim of the study is to evaluate the pregnancy outcome and recurrence of the disease in patients with endometrioma. All patients who underwent laparoscopic surgery for endometrioma between January 2017- 2020 in Etlik Zubeyde Hanim Women Health Training and Research Hospital, had a stage 3-4 disease, and met the inclusion criteria were evaluated. The exclusion criteria were; being menopausal, having laparotomy for endometrioma surgery, or presence of concomitant leiomyoma. The post-operative reproductive outcome and the recurrence rate were evaluated. Out of the 97 patients recruited, 57 (58.8%) were followed up for infertility, while the remaining forty had no desire for future pregnancy. Sixty-seven patients had elective surgery, and 30 (30.9%) underwent emergency surgery. Pregnancy was achieved in 18 (31.5%) within 3-18 months (8.94±4.54) after surgery, of which seven (38.8%) were spontaneous pregnancies while 11 had pregnancy through assisted reproductive techniques. The live birth rate was 88.8%, thirteen term delivery. Out of 97 patients, only four (4,1%) had recurrent endometrioma. The total pregnancy rate was high in the secondary infertile group (44.8%-17.8%), and the IVF pregnancy rate (60%) was high in the primary infertile group. Endometrioma surgery can be recommended for selected patients while preserving ovarian tissue.


D’Hooghe TM, Debrock S, Hill JA, Meuleman C. Endometriosis and subfertility: is the relationship resolved? Semin Reprod Med [Internet]. 2003 May [cited 2022 Mar 20]; 21(2): 243–53. Available from: https://pubmed.ncbi.nlm.nih.gov/12917793/

Helbig M, Vesper AS, Beyer I, Fehm T. Does Nutrition Affect Endometriosis? Geburtshilfe Frauenheilkd [Internet]. 2021 Feb 1 [cited 2022 May 14]; 81(2): 191–9. Available from: https://pubmed.ncbi.nlm.nih.gov/33574623/

Burns WN, Schenken RS. Pathophysiology of endometriosis-associated infertility. Clin Obstet Gynecol [Internet]. 1999 Sep [cited 2022 Mar 20]; 42(3): 586–610. Available from: https://pubmed.ncbi.nlm.nih.gov/10451772/

Balasch J, Creus M, Fábregues F, Carmona F, Ordi J, Martinez-Román S, et al. Visible and non-visible endometriosis at laparoscopy in fertile and infertile women and patients with chronic pelvic pain: a prospective study. Hum Reprod [Internet]. 1996 [cited 2022 Mar 20]; 11(2): 387–91. Available from: https://pubmed.ncbi.nlm.nih.gov/8671229/

Meuleman C, Vandenabeele B, Fieuws S, Spiessens C, Timmerman D, D'Hooghe T. High prevalence of endometriosis in infertile women with regular ovulation and normozoospermic partners. Fertil Steril [Internet]. 2009 Jul [cited 2022 Mar 20]; 92(1): 68–74. Available from: https://pubmed.ncbi.nlm.nih.gov/18684448/

S Jenkins, D L Olive, A F Haney. Endometriosis: pathogenetic implications of the anatomic distribution - PubMed [Internet]. Obstet Gynecol. 1986 [cited 2022 Mar 20]: 335–8. Available from: https://pubmed.ncbi.nlm.nih.gov/3945444/

Redwine DB. Ovarian endometriosis: a marker for more extensive pelvic and intestinal disease. Fertil Steril [Internet]. 1999 Aug [cited 2022 Mar 20]; 72(2): 310–5. Available from: https://pubmed.ncbi.nlm.nih.gov/10439002/

Gupta S, Goldberg JM, Aziz N, Goldberg E, Krajcir N, Agarwal A. Pathogenic mechanisms in endometriosis-associated infertility. Fertil Steril [Internet]. 2008 Aug [cited 2022 Mar 20]; 90(2): 247–57. Available from: https://pubmed.ncbi.nlm.nih.gov/18672121/

Corte L della, di Filippo C, Gabrielli O, Reppuccia S, la Rosa VL, Ragusa R, et al. The Burden of Endometriosis on Women’s Lifespan: A Narrative Overview on Quality of Life and Psychosocial Wellbeing. Int J Environ Res Public Health [Internet]. 2020 Jul 1 [cited 2022 Apr 21]; 17(13): 1–17. Available from: https://pubmed.ncbi.nlm.nih.gov/32610665/

Peiris AN, Chaljub E, Medlock D. Endometriosis. JAMA [Internet]. 2018 Dec 25 [cited 2022 Apr 21]; 320(24): 2608. Available from: https://pubmed.ncbi.nlm.nih.gov/30575883/

Lee D, Kim SK, Lee JR, Jee BC. Management of endometriosis-related infertility: Considerations and treatment options. Clin Exp Reprod Med [Internet]. 2020 [cited 2022 Apr 21]; 47(1): 1–11. Available from: https://pubmed.ncbi.nlm.nih.gov/32088944/

Muzii L, di Tucci C, Galati G, Mattei G, Chine A, Cascialli G, et al. Endometriosis-associated infertility: Surgery or IYF? Minerva Obstetrics and Gynecology. 2021 Apr 1; 73(2): 226–32.

Duffy JMN, Arambage K, Correa FJS, Olive D, Farquhar C, Garry R, et al. Laparoscopic surgery for endometriosis. Cochrane Database Syst Rev [Internet]. 2014 Apr 3 [cited 2022 Mar 20]; 2014(4). Available from: https://pubmed.ncbi.nlm.nih.gov/24696265/

Hart RJ, Hickey M, Mauris P, Buckett W. Excisional versus ablative surgery for ovarian endometrioma. Cochrane Database of Systematic Reviews [Internet]. 2008 [cited 2022 Mar 20]; (2). Available from: https://pubmed.ncbi.nlm.nih.gov/18425908/

Benschop L, Farquhar C, van der Poel N, Heineman MJ. Interventions for women with endometrioma prior to assisted reproductive technology. Cochrane Database Syst Rev [Internet]. 2010 Nov 10 [cited 2022 Mar 20]; (11). Available from: https://pubmed.ncbi.nlm.nih.gov/21069706/

Canis M, Donnez JG, Guzick DS, Halme JK, Rock JA, Schenken RS, et al. Revised American Society for Reproductive Medicine classification of endometriosis: 1996. Fertil Steril [Internet]. 1997 [cited 2022 Mar 20]; 67(5): 817–21. Available from: https://pubmed.ncbi.nlm.nih.gov/9130884/

Tanos V, Sowah E. Mini-invasive Surgery Endometrioma surgery and possibilities of early disease control. Mini-invasive Surg [Internet]. 2020 Jun 24 [cited 2022 Apr 22]; 4: 39. Available from: www.misjournal.net

Yang C, Geng Y, Li Y, Chen C, Gao Y. Impact of ovarian endometrioma on ovarian responsiveness and IVF: a systematic review and meta-analysis. Reprod Biomed Online [Internet]. 2015 Jul 1 [cited 2022 Apr 22]; 31(1): 9–19. Available from: https://pubmed.ncbi.nlm.nih.gov/25982092/

Ferrero S, Scala C, Tafi E, Racca A, Venturini PL, Leone Roberti Maggiore U. Impact of large ovarian endometriomas on the response to superovulation for in vitro fertilization: A retrospective study. Eur J Obstet Gynecol Reprod Biol [Internet]. 2017 Jun 1 [cited 2022 Apr 22]; 213: 17–21. Available from: https://pubmed.ncbi.nlm.nih.gov/28407512/

Singh M, Kaur KK, Allahbadia G. Current Role of Surgery in Endometriosis; Indications and Progress. 2018 [cited 2022 Apr 22]; Available from: https://www.researchgate.net/publication/325089607

Endometriosis guideline [Internet]. [cited 2022 Apr 22]. Available from: https://www.eshre.eu/Guidelines-and-Legal/Guidelines/Endometriosis-guideline.aspx

Beretta P, Franchi M, Ghezzi F, Busacca M, Zupi E, Bolis P. Randomized clinical trial of two laparoscopic treatments of endometriomas: cystectomy versus drainage and coagulation. Fertil Steril [Internet]. 1998 Dec [cited 2022 Mar 21]; 70(6): 1176–80. Available from: https://pubmed.ncbi.nlm.nih.gov/9848316/

Alborzi S, Ravanbakhsh R, Parsanezhad ME, Alborzi M, Alborzi S, Dehbashi S. A comparison of the follicular response of ovaries to ovulation induction after laparoscopic ovarian cystectomy or fenestration and coagulation versus normal ovaries in patients with endometrioma. Fertil Steril [Internet]. 2007 Aug [cited 2022 Mar 21]; 88(2): 507–9. Available from: https://pubmed.ncbi.nlm.nih.gov/17433319/

Endometriosis and infertility: a committee opinion. Fertil Steril [Internet]. 2012 [cited 2022 Apr 23]; 98(3): 591–8. Available from: https://pubmed.ncbi.nlm.nih.gov/22704630/

Endometriosis: diagnosis and management NICE guideline. 2017 [cited 2022 Apr 23]; Available from: www.nice.org.uk/guidance/ng73

Pais AS, Flagothier C, Tebache L, Almeida Santos T, Nicolle M. Impact of Surgical Management of Endometrioma on AMH Levels and Pregnancy Rates: A Review of Recent Literature. J Clin Med [Internet]. 2021 Feb 1 [cited 2022 Apr 25]; 10(3): 1–12. Available from: https://pubmed.ncbi.nlm.nih.gov/33499120/

Guo SW. Recurrence of endometriosis and its control. Hum Reprod Update [Internet]. 2009 [cited 2022 Apr 23]; 15(4): 441–61. Available from: https://pubmed.ncbi.nlm.nih.gov/19279046/

Parazzini F, Bertulessi C, Pasini A, Rosati M, di Stefano F, Shonauer S, et al. Determinants of short term recurrence rate of endometriosis. Eur J Obstet Gynecol Reprod Biol [Internet]. 2005 Aug 1 [cited 2022 Apr 23]; 121(2): 216–9. Available from: https://pubmed.ncbi.nlm.nih.gov/16054965/

Tandoi I, Somigliana E, Riparini J, Ronzoni S, Vigano’ P, Candiani M. High Rate of Endometriosis Recurrence in Young Women. J Pediatr Adolesc Gynecol. 2011 Dec 1; 24(6): 376–9.

Lee HJ, Lee JE, Ku SY, Kim SH, Kim JG, Moon SY, et al. Natural conception rate following laparoscopic surgery in infertile women with endometriosis. Clin Exp Reprod Med [Internet]. 2013 Mar [cited 2022 Apr 23]; 40(1): 29–32. Available from: https://pubmed.ncbi.nlm.nih.gov/23614113/

Hui Y, Zhao S, Gu J, Hang C. Analysis of factors related to fertility after endometriosis combined with infertility laparoscopic surgery. Medicine [Internet]. 2020 [cited 2022 Apr 23]; 99(21). Available from: https://pubmed.ncbi.nlm.nih.gov/32481283/

?ükür YE, Özmen B, Yak??t?ran B, Atabeko?lu CS, Berker B, Aytaç R, et al. Endometrioma surgery is associated with increased risk of subsequent assisted reproductive technology cycle cancellation; a retrospective cohort study. J Obstet Gynaecol [Internet]. 2021 [cited 2022 Mar 21]; 41(2): 259–62. Available from: https://pubmed.ncbi.nlm.nih.gov/32496142/

Prefumo F, Rossi AC. Endometriosis, endometrioma, and ART results: Current understanding and recommended practices. Best Pract Res Clin Obstet Gynaecol. 2018 Aug 1; 51: 34–40.




How to Cite

Atalay Mert, S., Dilbaz, B., Kose, C., & Engin Ustun, Y. (2022). Evaluation of the Laparoscopic Cystectomy for Endometrioma in Women of the Reproductive Age . Tropical Health and Medical Research, 5(1). https://doi.org/10.35916/thmr.v4i1.75