Clinical Investigation of Recurrence, Oncological, and Obstetrical Outcomes in Patients with Ovarian Atypical Endometriosis

<b>Objectives</b>: The objective of this study was to evaluate the safety of postoperative in vitro fertilization (IVF) for atypical endometriosis (AE) in terms of ovarian endometrioma recurrence and development of endometriosis-related ovarian cancer (EAOC). <b>Methods</b>: Premenopausal women with AE who had undergone ovarian surgery between 2008 and 2022 and had attended follow-up appointments for at least 3 months were included in this retrospective study. The recurrence of endometriosis, postoperative pregnancy rate, occurrence of postoperative EAOC in cases of AE, and independent risk factors of AE recurrence were analyzed. <b>Results</b>: A total of 105 patients were included in the study with a median age of 33 years (range, 16-50 years) and a median follow-up duration of 29.0 months (range, 3-143 months). Most of the patients were treated with cyst enucleation (96.2%). Recurrent ovarian endometrioma was detected in 19 patients (18.1%), 4 of whom (19.0%) underwent reoperation, and there were no cases of EAOC. The cumulative recurrence rate at 12, 24, and 50 months was 7.4, 15.8, and 26.3%, respectively. Among the 105 patients, 36 wanted to become pregnant; of these, 12 underwent IVF, which, according to a univariable analysis, did not increase their risk of recurrent ovarian endometrioma. According to a subsequent multivariable analysis, previous history of ovarian endometrioma operation was the sole significant risk factor for AE recurrence (HR, 4.246; 95% CI, 1.262-14.285; <i>p</i> = 0.020). <b>Conclusions</b>: IVF trials for pregnancy did not represent a risk factor for recurrence, as treated AE showed a low possibility of malignant transformation, and IVF was not a risk factor for recurrence.