Impact of non-medical treatments of endometrioma on pregnancy outcome: a systematic review and meta-analysis.

This meta-analysis assesses the impact of non-medical endometrioma treatments on pregnancy rates in infertile women with endometriosis. Based on a search of PubMed, Scopus, EMBASE and Web of Science, 24 prospective English-language studies (2000-2022, participant age 15-45 years, n = 2458) were identified that reported treatment and pregnancy rates based on the 2020 PRISMA checklist. Random effects modelling minimized bias; heterogeneity (I²) and publication bias were assessed using MedCalc. The results showed 95% confidence intervals, and statistical comparisons were performed using the Kruskal-Wallis, analysis of variance or chi-squared test. It was found that cystectomy and ablation yielded similar pregnancy rates: 39.28% and 42.94% for ART, and 40.25% and 34.08% for natural pregnancies (P > 0.05). Sclerotherapy and no treatment also resulted in acceptable pregnancy rates while coagulation and fenestration were associated with lower success rates and higher recurrence (up to 38.79%). Overall, cystectomy and ablation were considered as effective alternatives for improving fertility outcomes in this population. Future research on endometriomas and infertility should involve well-designed randomized controlled trials with larger and more diverse populations, additional fertility factors and standardized follow-up periods.