Laparoscopic excision of endometriomas and ovarian reserve

To the Editor:

We read with great interest the article by Celik et al. (1) about the reduction of ovarian reserve in patients submitted to laparoscopic ovarian endometrioma excision. The topic of endometriosis and ovarian reserve is extremely interesting and has been extensively debated in the literature. Our group was the first to report a reduction of AMH levels in patients with endometriosis (2), and others have shown also a significant reduction of ovarian reserve after surgery in this group of patients (3). However, what caught our attention in this paper was the finding that after endometrioma excision, patients presented significantly lower levels of AMH while a significantly higher number of antral follicles was observed.

Endometrioma and in vitro fertilization

To the Editor:

We read the article by Almog et al. (1) with interest. Similar to what we showed on a smaller scale (2), and in contrast to what showed by Somigliana et al. (3), they found that the number of oocytes retrieved from a cohort of patients bearing endometrioma and undergoing in vitro fertilization (IVF) is similar to that retrieved from unaffected patients, and that the presence of unilateral endometriomas has no impact of the number of oocytes retrieved. The straightforward recommendation was that one should proceed to IVF without preliminary removal of endometrioma (1). This is similar to what was suggested by Garcia-Velasco et al (4).

The impact on ovarian reserve after laparoscopic ovarian cystectomy

To the Editor:

The importance of ovarian preservation in patients with infertility related endometriosis has long been debated (1). Endometriomas do impair fertility and studies have demonstrated improved IVF outcomes after ovarian cystectomy and treatment of endometriosis in matched controlled studies (2). The article by Tsolakidis et al. (1) deserves praise for several points and also raises some concern, as others may use this information as a guide in the treatment of their patients with endometriomas.

Arguments for a left lateral predisposition of endometrioma.

To the Editor:

Matalliotakis and colleagues, in the April 2009 issue of Fertility and Sterility, present an argument for the left lateral predisposition of ovarian endometriomas based on a retrospective series of 251 women who underwent surgical intervention for the disease (1). They also suggest a new ‘female varicocele theory’ for the development of ovarian endometriomas based on the left lateral predilection of ovarian vein dilation (2).

Re: The effect of surgical treatment for endometrioma on in vitro fertilization outcomes: a systematic review and meta – analysis.

To the Editor:

We read the article by Tsoumpou et al. (1) with interest and commend the authors’ attempt to address this topical issue. The decision on what to do with regard to endometriomas in women having IVF remains an everyday challenge. The authors have done well to summarize the available data addressing this issue.