National survey of the current management of endometriomas in women undergoing assisted reproductive treatment
Open Access
- 13 June 2012
- journal article
- research article
- Published by Oxford University Press (OUP) in Human Reproduction
- Vol. 27 (9), 2712-2719
- https://doi.org/10.1093/humrep/des195
Abstract
What is the current management of women with ovarian endometriomas undergoing assisted reproductive treatment (ART) in the UK? It appears that the majority of gynaecologists in the UK offer surgery (mostly cystectomy) for endometriomas prior to ART, regardless of the presence of symptoms. The ideal management of endometriomas in women undergoing ART remains controversial and presents a dilemma to reproductive specialists. This was a national cross-sectional survey. A total of 388 gynaecologists completed the questionnaire. All clinicians fully registered with the Royal College of Obstetricians and Gynaecologists were contacted. An 11-item survey was administered electronically using Survey Monkey software. Quantitative data were analysed using descriptive and comparative statistics. The majority of responders were consultants (65%), 25% practiced ART and 65% performed laparoscopic surgery. Overall, 95% of responders would offer surgery for endometriomas in women undergoing ART, either on the basis of the size (>3–5 cm) of the endometrioma (52%), the presence of symptoms (16%), the presence of multiple/bilateral endometriomas (2%), regardless of the size and symptoms (19%) or only to women undergoing IVF (6%). The remaining 5% of responders would not offer surgery before ART. Excision was the most common surgical modality (68%), followed by ablation (25%). Laparoscopic surgeons were almost twice as likely to ‘offer surgery to all patients with endometriomas prior to ART’ compared with clinicians performing laparotomy (22 versus 12%, P < 0.001). Our overall response rate, with answers to the questionnaire, was low (15%). However, the response rate amongst reproductive specialists was estimated at 60%. It is possible that there might have been an element of bias towards over-representation of responders who are more concerned about ‘normalization’ of the pelvic anatomy. Furthermore, our survey relied on self-reporting of practice and it is possible that being presented with a list of ‘ideal’ options may have resulted in respondent bias. Despite the available evidence that surgery for endometriomas does not improve the outcome of ART and may damage ovarian reserve, it seems that the majority of gynaecologists in the UK offer ovarian cystectomy to their patients. None.Keywords
This publication has 23 references indexed in Scilit:
- Geschlechtsspezifische Wahrnehmung des orthopädisch-unfallchirurgischen Berufsbilds während des MedizinstudiumsZeitschrift für Orthopädie und Unfallchirurgie, 2011
- '20 days protected learning' - students' experiences of an overseas nurses programme - 4 years on: a retrospective surveyBMC Nursing, 2011
- Prescribing habits and caregiver satisfaction with resources for dosing children: Rationale for more informative dosing guidanceBMC Pediatrics, 2011
- Religious and Spiritual Beliefs of Gynecologic Oncologists May Influence Medical Decision MakingInternational Journal of Gynecologic Cancer, 2011
- The spectrum of management practices in nontraumatic subarachnoid hemorrhage: A survey of high-volume centers in the United StatesSurgical Neurology International, 2011
- Effects of excision of ovarian endometrioma on the antral follicle count and collected oocytes for in vitro fertilizationFertility and Sterility, 2010
- The effect of surgical treatment for endometrioma on in vitro fertilization outcomes: a systematic review and meta-analysisFertility and Sterility, 2009
- Outcome of in vitro fertilization/intracytoplasmic sperm injection after laparoscopic cystectomy for endometriomasFertility and Sterility, 2006
- Damage to ovarian reserve associated with laparoscopic excision of endometriomas: A quantitative rather than a qualitative injuryAmerican Journal of Obstetrics and Gynecology, 2005
- Laparoscopic excision of ovarian cysts: is the stripping technique a tissue-sparing procedure?Fertility and Sterility, 2002