Frontiers in endocrinology · 2026
Impact of endometriotic cystectomy on ovarian reserve function and ovulation induction outcomes in women with endometriosis undergoing assisted reproductive technology.
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Li Yutao, Gong Yu, Jiang Haiyan, Ji Meng
Аннотация
BACKGROUND: This study aims to evaluate the impact of endometriotic cysts and prior ovarian endometriotic cystectomy on ovarian reserve function in women with endometriosis undergoing assisted reproductive technology.
METHODS: In this retrospective cohort study, 3,517 endometriosis patients receiving in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) between January 2016 and April 2022 were reviewed. Participants were stratified into three groups: Group A (control, n=494): patients without endometriosis undergoing IVF/ICSI for male factor infertility; Group B (non-surgical, n=217): endometriosis patients with untreated endometriotic cysts; Group C (surgical, n=122): endometriosis patients with prior cystectomy. Antral follicle count (AFC), follicle-stimulating hormone (FSH), anti-Müllerian hormone (AMH), gonadotropin (Gn) dose, number of retrieved oocytes, number of mature metaphase II (MII) oocytes and the proportion of patients with diminished ovarian reserve (DOR; AMH<1.1ng/ml) were compared across groups.
RESULTS: Ovarian reserve markers were highest in Group A [AMH: 2.88 (1.64-4.45) ng/mL; AFC: 13 (8.5-17)], followed by Group B [AMH: 2.70 (1.59-4.05) ng/mL; AFC: 11 (7-16)], with both significantly exceeding Group C [AMH: 1.97 (1.02-3.05) ng/mL; AFC: 10 (4-15)] (all P < 0.01). The incidence of DOR was significantly higher in Group C (26.23%) than in Group A (13.56%) and Group B (12.90%) (P < 0.05). The total Gn dose was significantly higher in Groups B and C than in Group A. The number of retrieved oocytes and MII oocytes did not differ significantly between Groups A and B, but both were significantly higher than in Group C (P < 0.01).
CONCLUSIONS: A history of endometriotic cystectomy is associated with significantly diminished ovarian reserve and poorer ovarian response during controlled ovarian stimulation. These findings highlight the importance of individualized surgical decision-making for reproductive-aged women with endometriomas, weighing potential benefits against the risk of iatrogenic damage to ovarian function.
METHODS: In this retrospective cohort study, 3,517 endometriosis patients receiving in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) between January 2016 and April 2022 were reviewed. Participants were stratified into three groups: Group A (control, n=494): patients without endometriosis undergoing IVF/ICSI for male factor infertility; Group B (non-surgical, n=217): endometriosis patients with untreated endometriotic cysts; Group C (surgical, n=122): endometriosis patients with prior cystectomy. Antral follicle count (AFC), follicle-stimulating hormone (FSH), anti-Müllerian hormone (AMH), gonadotropin (Gn) dose, number of retrieved oocytes, number of mature metaphase II (MII) oocytes and the proportion of patients with diminished ovarian reserve (DOR; AMH<1.1ng/ml) were compared across groups.
RESULTS: Ovarian reserve markers were highest in Group A [AMH: 2.88 (1.64-4.45) ng/mL; AFC: 13 (8.5-17)], followed by Group B [AMH: 2.70 (1.59-4.05) ng/mL; AFC: 11 (7-16)], with both significantly exceeding Group C [AMH: 1.97 (1.02-3.05) ng/mL; AFC: 10 (4-15)] (all P < 0.01). The incidence of DOR was significantly higher in Group C (26.23%) than in Group A (13.56%) and Group B (12.90%) (P < 0.05). The total Gn dose was significantly higher in Groups B and C than in Group A. The number of retrieved oocytes and MII oocytes did not differ significantly between Groups A and B, but both were significantly higher than in Group C (P < 0.01).
CONCLUSIONS: A history of endometriotic cystectomy is associated with significantly diminished ovarian reserve and poorer ovarian response during controlled ovarian stimulation. These findings highlight the importance of individualized surgical decision-making for reproductive-aged women with endometriomas, weighing potential benefits against the risk of iatrogenic damage to ovarian function.