Live birth rate following endometrial preparation with daily versus depot GnRH agonist.

BACKGROUND: Gonadotrophin-releasing hormone agonist (GnRHa) downregulates gonadotropin secretion in the pituitary gland. It is used both in ovulation induction protocols and in artificial endometrium preparation. Frozen-thawed embryo transfer to artificially prepared endometrium (FET-APE) is a frequent procedure in vitro fertilization (IVF) which requires GnRHa. It can be used either as a daily low-dose injection or as a single depot injection. It is unclear which of these two regimens is superior for artificial endometrium preparation. METHODS: We evaluated the data of 72 patients who had undergone frozen embryo transfer following the 5th day Preimplantation Genetic Test-aneuploidy (PGT-A) between 2018-2021. All embryos were genetically screened, and euploid single embryos were transferred. Group 1 (n: 36) used depot GnRHa, and Group 2 (n: 36) used single daily injections for artificial endometrial preparation. The outcomes for Beta Human Chorionic Gonadotrophin (BHCG) positivity and live birth rates (LBR) was compared. RESULTS: The BHCG positivity for Group 1 and Group 2 was 75% and 80.6%, respectively. The LBR for Group 1 and Group 2 were found to be 58.3% and 63.9%, respectively. There was no statistically significant differences between the two groups. CONCLUSIONS: In artificial endometrium preparation, depot GnRHa offers cheaper and more convenient alternative to single daily dose injections, particularly in busy clinical settings.

Gonadotrophin-releasing hormone agonist (GnRHa) is used to Frozen­thawed embryo transfer to artificially prepared endometrium (FET-APE). However, it is not known which of the depot and daily preparations is more effective. Our study to exclusively compare 5th day euploid single embryos transferred in FET-APE cycles using depot or daily injections of GnRHa to avoid any influences of oocyte or spermatozoa dependent factors on Beta Human Chorionic Gonadotrophin (BHCG) positivity and live birth rates (LBR). The results were similar. Since the results are similar, the depot GnRHa form can be preferred for ease of use. However, future studies on larger series and patients with different clinical characteristics may effects the results.

Repeated application of luteal phase oestradiol/GnRH antagonist priming increases IVF success for poor ovarian reserve patients.

We aimed to compare repeated LPP (luteal phase oestradiol LPP/GnRH antagonists protocol) treatment with different protocol results with poor ovarian response (POR) patients. Two hundred and ninety-three cycles with poor ovarian reserve who underwent LPP, microdose flare up protocol and antagonist protocol were included in the study. Of these, 38 patients were applied LPP in the first cycle and LPP in the second cycle. After the microdose or antagonist protocol applied in the first cycle, LPP was applied to 29 patients in the second cycle. There are 128 patients who received LPP only once and 31 patients who received microdose flare up only once. The clinical pregnancy rate was monitored higher in LPP application group in the second cycle than the patients who received only LPP and patients who received LPP after different protocols (p = .035). b-hCG positivity per embryo and clinical pregnancy rate were found to be significantly higher with the LPP application in the second protocol (p = .000, p = .001). Repeated LPP may be the first choice protocol for low ovarian reserve patients.

What is already known on this subject? There is no standard treatment protocol applied to patients with low ovarian reserve. In this patient group, the rate of lack of response to stimulation and cycle cancellation is high. Increasing FSH level in patients with poor ovarian reserve causes the formation of larger follicles by increasing the sensitisation of follicles in the late luteal phase.What do the results of this study add? Our study was conducted for the first time in the literature. We compared the results of second cycle LPP (luteal phase oestradiol LPP/GnRH antagonists protocol) application in patients with low ovarian reserve who resulted in failed IVF after commonly used LPP, microdose flare up protocol and antagonist protocols.What are the implications of these findings for clinical practice and/or further research? Luteal phase oestrogen LPP/GnRH antagonist may be the first choice in patients with poor ovarian reserve patients. In unsuccessful cases, the LPP protocol should be considered in the retreatment for the second time.

Double daily doses of cetrorelix may raise follicular phase progesterone more compared to single doses in poor ovarian response patients.

PURPOSE: There is evidence that follicular phase progesterone rise [FPPR] adversely affects fresh in vitro fertilization [IVF] cycles. A single daily dose of cetrorelix has been used to prevent early luteinizing Hormone (LH) surge. We speculated that doubling the daily dose might have a positive effect in patients who have early LH surges despite receiving the single daily dose treatment. However, a double daily dose of cetrorelix seems to cause FPPR in poor ovarian response (POR) patients. MATERIALS AND METHODS: On human chorionic gonadotropin [hCG] injection days, the progesterone levels of POR patients who received a single daily dose of cetrorelix (group 1, n = 59) were compared with progesterone levels of the patients who received a double daily dose of cetrorelix (group 2, n = 75). The two groups had statistically similar demographic data. The patients who had FPPR were detected, and a comparison of progesterone levels, using 0.8, 1.0, and 1.2 [ng/mL] of progesterone as cut-off levels, was made between patients of both groups. RESULTS: FPPR patients in group 2 had significantly higher progesterone levels during hCG day, contrary to expectations. When progesterone cut-off levels of 0.8, 1.0, and 1.2 [ng/mL] were used for group 1 patients, 15.3%, 13.6%, and 6.8% of the patients developed FPPR, respectively When the progesterone cut-off levels of 0.8, 1.0, and 1.2 [ng/mL] were used for group 2, the results detected were 45.3%, 30.7%, and 21.3%, respectively. A significant statistical difference in progesterone levels was observed between the groups. CONCLUSION: While the double daily dose of cetrorelix was initially thought to more effectively suppress early LH rise by some authors, we have seen that it increases the FPPR more when compared to a single daily dose regime. We suggest using frozen cycles instead of fresh cycles in order to have better endometrial receptivity in patients who seem to benefit from higher daily doses of cetrorelix.

Abdominal obesity is associated with a lower ankle-brachial index in women with polycystic ovary syndrome.

Polycystic ovary syndrome (PCOS) was linked to increased lifetime risk of cardiovascular disease. A low ankle-brachial index (ABI) is associated with accelerated atherosclerosis. The ABI value and the associated conditions in women with PCOS were searched in the present study. The ABI was measured using a handheld Doppler device and calculated using both standard and modified definitions. Women with PCOS (n = 103, mean age = 24.9 ± 5.9 years) had a mean ABI of 1.10 ± 0.10. A low ABI (≤0.9) was 2.9% and 14.6% using the standard and modified definitions, respectively. Mean ABI correlated negatively to body weight, BMI, waist circumference, waist-to-hip ratio, and hematocrit. Logistic regression analysis revealed higher waist-to-hip ratio as independently associated with a lower ABI. Frequency of ABI ≤0.9 in PCOS was lower than the general population. However, increased waist-to-hip ratio was a predictor of a lower ABI value.

The levels of nitric oxide and asymmetric dimethylarginine in the rat endometriosis model.

AIM: To investigate the levels of nitric oxide (NO) and asymmetric dimethylarginine (ADMA) in all the rat endometriosis models. MATERIAL & METHODS: Forty-one rats with endometriotic implants were divided into four groups (1 to 4) and administered infliximab, etanercept, letrozole and control, respectively. There were 11 rats in group 5 (normal). The size of implants, plasma ADMA and nitrate/nitrite (NO(x) ) levels and histological score were assessed. RESULTS: In groups 1, 2 and 3, plasma ADMA levels were higher than groups 4 and 5, 296.8 ± 66.2, 285.9 ± 35.7, 200.3 ± 41.0, 125.3 ± 16.7, 111.3 ± 6.5 µmol/L, respectively, while NO(x) levels were lower than groups of control and normal 19.6 ± 3.8, 19.8 ± 4.4, 39.3 ± 6.1, 80.5 ± 5.3, and 91.1 ± 5.0 µmol/L, respectively. CONCLUSIONS: Infliximab, etanercept and letrozole have regressed endometriotic implants, decreased plasma NO(x) levels, and increased plasma ADMA levels.

Efficiency and pregnancy outcome of serial intrauterine device-guided hysteroscopic adhesiolysis of intrauterine synechiae.

OBJECTIVE: To highlight the efficiency of intrauterine device (IUD) guidance during hysteroscopic adhesiolysis for severe intrauterine adhesions. DESIGN: A prospective, randomized trial. SETTING: Private tertiary and referral infertility clinic. PATIENT(S): Seventy-one subfertile patients who underwent hysteroscopic treatment of intrauterine synechiae or adhesions. INTERVENTION(S): Thirty-six women in group 1 were initially examined by laparoscopy-hysteroscopy at first look, and an IUD was inserted during hysteroscopic adhesiolysis. The adhesions were further lysed by the guidance of IUD during the second-look office hysteroscopy, 1 week later. Patients were prescribed 2 months of estrogen as well as P therapy, and the IUD was removed by the end of this period. The uterine cavity was evaluated, and adhesions were further lysed by a third-look office hysteroscopy, 1 week after the removal of IUD. Thirty-five women in group 2 were similarly examined by first-look office hysteroscopy, and an IUD was inserted during hysteroscopic adhesiolysis. These patients did not undergo early intervention of office hysteroscopy, 1 week after the first procedure. They also used 2 months of estrogen and P therapy. The IUD was removed by the end of this period, and the uterine cavity was evaluated and adhesions were further lysed during a second-look office hysteroscopy. MAIN OUTCOME MEASURE(S): Pregnancy rate and live birth rate. RESULT(S): Spontaneous pregnancy rates after treatment were 17/36 (47.2%) and 11/35 (30%), and live birth rates were 10/36 (28%) and 7/35 (20%) in groups 1 and 2, respectively. These differences between the two groups were not statistically significant. CONCLUSION(S): The method described especially for early intervention may prevent complications during the treatment of severe intrauterine adhesions and may present a secure and effective alternative for constructive clinical outcomes.

Tension-free vaginal tape for surgical relief of intrinsic sphincter deficiency: results of 5-year follow-up.

STUDY OBJECTIVE: We evaluated effectiveness of tension-free vaginal tape application for surgical relief of intrinsic sphincter deficiency. DESIGN: A prospective study (Canadian Task Force classification II-3). SETTING: Tertiary center of medical faculty. PATIENTS: We studied 47 patients. INTERVENTIONS: Tension-free vaginal tape procedure, questionnaire form, stress test, cotton swab test, and functional bladder volume measurements. MEASUREMENTS AND MAIN RESULTS: Patients were grouped as intrinsic sphincter deficiency according to American College of Obstetricians and Gynecologists criteria. Operative results were documented at 6, 12, 36, and 60 months after the procedure by using a questionnaire form and objective tests of stress test, cotton swab test, and mean bladder functional volume measurement. At first visit 6 months after procedure, 70% (n = 35) of patients were completely satisfied, 9 (18%) had improved urine control, and 5 (10%) had no change in urine control. Results were: 72% (n = 36), 12% (n = 6), and 14 (n = 7%) at the end of the first year, and 66% (n = 33), 20% (n = 10), and 14% (n = 7) at the end of the third year, respectively. The fifth year's follow-up visit revealed 57.4% (n = 27 of 47) satisfaction, 17.02% (8 of 47) improved urine control, and 25.5% (12 of 47) no change in urine control. CONCLUSION: Tension-free vaginal tape procedure is a safe and effective technique for patients who have exclusively intrinsic sphincter deficiency. Long-term results will clarify the value of this procedure in comparison with classic antistress surgical techniques.

Does mode of delivery affect sexual functioning of the man partner?

INTRODUCTION: Recent surveys showed that the major reasons for avoiding vaginal delivery were the fear of childbirth and the concern for postpartum sexual health. Although sexual dysfunction is a disorder that affects a couple rather than an individual, all studies investigating the relationship between the mode of delivery and sexual problems have been conducted only in cohorts of women. AIM: To determine the effect of mode of delivery on quality of sexual relations and sexual functioning of men by using the Golombock-Rust Inventory of Sexual Satisfaction (GRISS). MAIN OUTCOME MEASURE: Mean score of sexual function and prevalence of sexual dysfunction in overall and specific areas of the GRISS were compared among the three groups. METHODS: A total of 107 men accompanying their wives in outpatient clinics of obstetrics and gynecology met inclusion/exclusion criteria. Three groups of men were defined; men whose partners had: (i) "elective cesarean delivery" (N = 21; mean age 32.2 +/- 3.8 years); (ii) "vaginal delivery with mediolateral episiotomy" (N = 36; mean age 31.4 +/- 4.5 years); and (iii) "not given birth" (N = 50; mean age 28.8 +/- 4.0 years). RESULTS: Mean overall sexual function score (normal value < 25 points) was 20.5 +/- 8.2 in the elective caesarean group, 19.3 +/- 6.5 in the vaginal delivery group, and 18.8 +/- 9.3 in the nulliparae group (P = 0.731). Prevalence of sexual dysfunction in men was 28.6% in the elective caesarean group, 19.4% in the vaginal delivery group, and 30.0% in the nulliparae group (P = 0.526). CONCLUSION: Overall sexual function of men was not affected by their partner's parity and mode of delivery. An elective cesarean section simply because of concerns about sexual function would not provide additional benefit to men, and could deny women a possible vaginal delivery, which is generally assumed to be safer than cesarean section.

Isolated torsion of fallopian tube in a premenarcheal 12-year-old girl.

Isolated torsion of fallopian tubes should be considered even at premenarcheal ages in cases of acute pelvic pain, and prompt surgery can preserve the tube and thus fertility. It is an uncommon emergency event and a difficult condition to evaluate clinically. This report focuses on a 12-year-old premenarcheal girl who presented with acute pelvic pain of 2 days. Pelvic ultrasound showed an adnexal mass on the left side. Laparoscopy was performed and an isolated tubal torsion was discovered. The tube was necrotic and salpingectomy was performed. The appendix appeared to be hyperemic and erectile. Appendectomy was also performed to rule out appendicitis. It's our recommendation that in the differential diagnosis of acute lower abdominal pain of girls, isolated torsion of the fallopian tubes should be considered. Also, preservation of the tube and fertility should be possible with prompt surgical intervention.

The effect of pre-eclampsia on complete blood count, platelet count and mean platelet volume.

Pre-eclampsia is a condition observed during pregnancy and threatens the life of both mother and foetus. There are studies, which suggest platelets play a major role in the pathogenesis of pre-eclampsia. The aim of this study is to compare the complete blood count (CBC) parameters, especially platelet count and mean platelet volume (MPV), in pre-eclamptic and normal pregnant women and to evaluate whether these parameters have a prognostic significance in determining the severity of eclampsia. The study and control groups consist of 56 pre-eclamptic and 43 normal pregnant women, respectively. There was no statistically significant difference according to CBC, platelet count and MPV when pre-eclamptic and severely pre-eclamptic patients were compared with controls. As a result, we observed no prognostic significance of CBC, platelet count and MPV on the presence and/or severity of pre-eclamptic condition. There are conflicting results especially on the significance of MPV in the literature, and possibly this confliction is due to the difference between methods and/or equipments used for automated blood count.

Efficacy of laparoscopically-assisted extracorporeal cystectomy in patients with ovarian endometrioma.

STUDY OBJECTIVE: To investigate the usefulness and effectiveness of the extracorporeal surgical technique in the treatment of endometriomas. DESIGN: Retrospective evaluation (Canadian Task Force Classification II-2). SETTING: Department of gynecology in a tertiary care faculty hospital and training hospital. PATIENTS: Of 89 patients with endometrioma, 53 had laparoscopic stripping, and 36 had laparoscopically-assisted extracorporeal cystectomy. INTERVENTIONS: Laparoscopic stripping and laparoscopically-assisted extracorporeal cystectomy were performed for the treatment of endometriomas diagnosed laparoscopically. MEASUREMENTS AND MAIN RESULTS: The size of the endometrioma diagnosed by the ultrasonographic examination was not statistically related to the severity of the endometriosis (p = .42). Conversion to extracorporeal technique was required in 17 of 58 cases with moderate endometriosis and 14 of 31 cases with severe endometriosis (p = .04). Operation time, visual analogue pain score, and hospitalization periods were similar between the 2 techniques. Among 53 specimens obtained with laparoscopic stripping, 29 (55%) had no ovarian tissue, and 24 (45%) had ovarian tissue with follicles. Of 36 specimens obtained with extracorporeal technique, 19 (52%) had no ovarian tissue, and 17 (48%) had ovarian tissue with follicles. Preservation of the ovarian tissue was not significantly different between both surgical techniques. CONCLUSIONS: Extracorporeal technique with laparoscopically-assisted minilaparotomy is a valuable alternative for laparoscopic stripping in selected cases.

Oronasopharyngeal suction versus no suction in normal and term infants delivered by elective cesarean section: a prospective randomized controlled trial.

BACKGROUND/AIM: There are controversies about the routine use of oronasopharyngeal suction (ONPS) in healthy infants. This study aimed to compare the effects of oronasopharyngeal suction with those of no suction in normal, term infants delivered by cesarean section. METHODS: 140 term, healthy newborns of uncomplicated pregnancies were prospectively randomized to one of two groups according to the use of ONPS procedure. Differences in oxygen saturation levels, heart rates, and Apgar scores were determined. RESULTS: The mean SaO(2) values through the 2nd and 6th min of life were significantly higher in the no suction group (p < 0.001). The maximum time to reach SaO(2) of > or =92% (6 vs. 11 min) and > or =86% (5 vs. 8 min) saturation were shorter in the no suction group than in the ONPS group. The mean heart rates were consistently and significantly lower in the no suction group during the first 6 min except the second one. All neonates without suction had an Apgar score of 10 at the 5th min, while the mean +/- SD for ONPS group was 9.34 +/- 0.48 (p < 0.001). CONCLUSION: Although findings remained on statistical level and did not lead to clinically adverse outcomes, there is no statistical or physiological basis for oronasopharyngeal suction as a systematic procedure in healthy, term infants delivered by cesarean section.

Serum and follicular fluid levels of soluble Fas and soluble Fas ligand in IVF cycles.

OBJECTIVE: To determine follicular fluid (FF) and serum levels of soluble Fas (sFas) and soluble Fas ligand (sFasL) in patients undergoing IVF cycles. STUDY DESIGN: A prospective comparative study among patients with endometriosis (n=12), infertility due to male factor (n=12) and poor responders (n=32) undergoing IVF cycles in Centrum IVF Clinic. Individual FF and serum samples were collected from patients during transvaginal ultrasonography-guided follicle aspiration. Patients were classified as poor responder patients undergoing IVF cycles with GnRHa, triptorelin and GnRH antagonist, cetrotide, patients with endometriosis and patients with infertility due to male factor. sFas, sFasL levels in both FF and serum samples and their correlations with clinical outcomes of IVF were measured in each study group. RESULTS: Serum and FF levels of sFas, sFasL were similar in the poor responder and male factor groups. There were no differences between the serum and FF levels of both sFas and sFasL among poor responder patients receiving either GnRH agonist or antagonist therapies. Serum levels of sFas were significantly lower in the endometriosis group compared to the male factor group. Serum and FF levels of sFas, sFasL were similar among patients with or without clinical pregnancy. CONCLUSION: sFas and sFasL are detected in both serum and follicular fluid samples from IVF cycles, their levels are similar between poor responder and male factor groups as well as between GnRH agonist and antagonist treatment groups. These soluble apoptotic factors may not be predictive for the outcomes of IVF. Decreased serum levels of sFas, suggests increased apoptosis in endometriosis.

Predictive value of glucose-insulin ratio in PCOS and profile of women who will benefit from metformin therapy: obese, lean, hyper or normoinsulinemic?

OBJECTIVE: The aim of the present study is to evaluate sub-groups of PCOS patients who will benefit from metformin therapy and to find out any predictors of ovulation in PCOS sub-groups. METHOD: In the current prospective-randomized, placebo-controlled, double-blind study, PCOS patients (n = 116) were divided into six main groups according to glucose to insulin ratio (G-I ratio mg/10(-4) U) and body mass index (BMI kg/m2) as: Group 1: normoinsulinemic (G-I ratio > or = 4.5 mg/10(-4) U), lean (BMI < 25) (n = 37); Group 2: normoinsulinemic, overweight (BMI: 25-29.9) (n = 19); Group 3: normoinsulinemic, obese (BMI > or = 30) (n = 18); Group 4: hyperinsulinemic (G-I ratio < 4.5 mg/10(-4) U), lean (n = 28); Group 5: hyperinsulinemic, overweight (n = 17); Group 6: hyperinsulinemic, obese (n = 20). Patients in each group were randomized onto placebo or metformin treatments (850 mg two to three times per day according to BMI). The rate of ovulation, biochemical profile, hormonal profile and clinical symptoms of hyperandrogenism were evaluated before and after 6 months of metformin and placebo treatments. RESULT(S): We observed a significant decrease in WHR following metformin therapy in the normoinsulinemic overweight sub-group (P < 0.05). The duration of the menstrual cycle significantly decreased in the normoinsulinemic obese sub-group on metformin therapy (P < 0.05). Metformin had a significant effect on hirsutism scores in hyperinsulinemic lean women (P < 0.05) and decreased DHEAS levels significantly in the lean hyperinsulinemic and normoinsulinemic groups (P < 0.05). Metformin had significant effects on ovulation in only lean hyperinsulinemic women (P < 0.05). CONCLUSIONS: Clinical outcomes of metformin therapy may be categorized on the basis of basal BMI and insulin levels in PCOS patients.

Metformin treatment in patients with polycystic ovary syndrome undergoing in vitro fertilization: a prospective randomized trial.

In the present study, we investigated the impact of metformin therapy on in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) outcomes in patients with polycystic ovary syndrome (PCOS). Metformin does not lead to any improvement in IVF/ICSI outcomes among patients with PCOS.

Oronasopharyngeal suction versus no suction in normal, term and vaginally born infants: a prospective randomised controlled trial.

This prospective randomised controlled trial aimed to compare the effects of oronasopharyngeal suction with those of no suction in normal, term and vaginally born infants and was performed at a Turkish tertiary hospital from June 2003 to January 2004. A total of 140 newborns were enrolled in the trial (n = 70 per group). The no suction group showed lower mean heart rates through the 3rd and 6th minutes and higher SaO(2) values through the first 6 mins of life (P < 0.001). The maximum time to reach SaO2 of >or= 92% (6 vs. 11 min) and >or= 86% (5 vs. 8 min) were shorter in the no suction group (P < 0.001).

Effect of bupivacaine after operative laparoscopic gynecologic procedures.

STUDY OBJECTIVE: To evaluate the effect of intraperitoneal installation and periportal infiltration of bupivacaine on postoperative pain and return of bowel function. DESIGN: A prospective, double-blind, randomized trial (Canadian Task Force classification I). SETTING: GATA School of Medicine, Department of Obstetrics and Gynecology, Reproductive Endocrinology Unit. PATIENTS: Eighty patients undergoing operative gynecologic laparoscopy. INTERVENTION: Periportal infiltration of local anesthesia with 10 mL 0.5% bupivacaine before incision and another 20 mL 0.5% bupivacaine diluted with 20 mL of saline or equal amount of physiologic saline injected into the peritoneal cavity at the end of the procedure. MEASUREMENTS AND MAIN RESULTS: Each patient recorded the severity of her pain on a visual analog scale (VAS) at 1, 6, 18, and 24 hours and the time of first bowel movement and first flatus after surgery. Seventy-seven patients completed the study (38 in the bupivacaine group; 39 in the control group). The severity of postoperative pain, as recorded on the VAS, was significantly less at 1, 6, 18, and 24 hours after surgery in the group receiving bupivacaine compared with those in the control group. The first bowel movement in the bupivacaine group occurred earlier than in the control group (284.80 +/- 31.62 min vs 453.23 +/- 33.08 min, p <.001); similarly, the first flatus occurred earlier in the bupivacaine group than in the control group (466.2 +/- 29.59 min vs 658.80 +/- 40.92 min p <.001). CONCLUSION: Intraperitoneal installation and periportal infiltration of bupivacaine decrease postoperative pain and hasten the return of bowel function. Both decreased postoperative pain and shortened duration for the return of bowel function are crucial for comfort and discharge of the patient.

Aspiration of ovarian endometriomas before intracytoplasmic sperm injection.

OBJECTIVE: To investigate whether aspiration of ovarian endometriomas before controlled ovarian stimulation (COH) improves intracytoplasmic sperm injection (ICSI) outcomes. DESIGN: Prospective study. SETTING: University hospital. PATIENT(S): A prospective analysis of 171 patients with ovarian endometriosis and tubal factor infertility were divided into four groups: aspiration of endometriomas at the beginning of COH in patients with ovarian endometriomas and no history of previous surgery (n = 41) (group 1); nonaspirated endometriomas (n = 40) (group 2); history of ovarian surgery for endometriomas in patients without ovarian endometriomas at the beginning of COH (n = 44) (group 3); and tubal factor infertility (n = 46) (control group 4). INTERVENTION(S): Aspiration of endometriomas. MAIN OUTCOME MEASURE(S): Clinical parameters, characteristics of COH, and ICSI results were analyzed. RESULT(S): We observed higher levels of E(2) on the day of hCG injection after aspiration of endometriomas compared with nonaspirated endometriomas. When we compared all endometriomas and tubal factor (control) groups, we observed a lower number of total follicles (>17 mm) and metaphase II (MII) oocytes in nonaspirated and resected endometrioma groups and a longer duration of COH in the nonaspirated endometrioma group compared with the tubal factor group. Implantation and clinical pregnancy rates were similar among all groups. CONCLUSION(S): In the current study, all patients with endometriomas had significantly lower numbers of MII oocytes compared with those in patients with tubal factor infertility. We propose that aspiration of endometriomas before COH neither reduces the amount of gonadotropins nor increases the number of follicles >17 mm, the number of MII oocytes retrieved, the implantation rates, or the clinical pregnancy rates. Resection of small endometriomas (1-6 cm) may not present any additional benefits to the IVF-ICSI cycle outcomes.