The impact of ovarian endometrioma on the in vitro fertilization outcomes

The incidence of ovarian endometrioma (OMA) among patients undergoing assisted reproductive technology (ART) programs ranges from 10.5 to 21.8%. Despite data on the possible gonadotoxic effect of OMA, their impact on the outcomes of ART programs remains a subject of debate. In this regard, the current study’s key objective was to conduct a comparative analysis of the parameters of the ovarian response and the embryological stage in patients with OMA and in women with tubal-peritoneal factor infertility (TPF) in order to assess the possible impact of OMA on the effectiveness of IVF. Objective. To evaluate the impact of primary OMAs measuring up to 4 cm on the processes of folliculogenesis, oogenesis, early embryogenesis, pregnancy rate (PR), and live birth in ART programs. Material and methods. A prospective cohort study was conducted in the Department of Assisted Reproductive Technologies in the Treatment of Infertility named after Professor B.V. Leonov at the National Medical Research Center for Obstetrics, Gynecology, and Perinatology named after V.I. Kulakov of the Ministry of Health of Russia between 2023 and 2025. Group 1 (the main group) consisted of patients with primary unilateral ovarian cyst <4 cm in size at the time of ovarian stimulation (n=120); Group 2 (comparison group) consisted of patients with tubal factor infertility (n=144). Results. An analysis was conducted of clinical and anamnestic data, parameters of the embryological stage, and outcomes of ART cycles in 264 patients aged 23 to 35 years with preserved ovarian reserve (OR). Patients with primary unilateral EC were characterized by statistically significantly lower levels of antral follicles, a lower frequency of obtaining mature oocytes (MII), and a lower frequency of blastocyst formation, as well as a lower frequency of embryo cryopreservation compared to women with TPF infertility (p<0.05). In group I, cancellation of the treatment cycle was more commonly observed due to the absence of cleavage, unsatisfactory embryo quality, or arrest of embryo development (p<0.001). The CPR per ovarian stimulation cycle, as well as the live-birth rate, in patients with OMA were statistically significantly lower than in the group of patients with TPF infertility (24% vs 40.6%, p=0.005, and 18.7% vs 31.6%, p=0.019, respectively). Conclusions. The presence of primary unilateral OMA up to 4 cm in size in women under 35 years of age with preserved ovarian function.