Influence of ovarian endometrioma on fertility.

ABSTRACT

OBJECTIVE: This study examines the influence of ovarian endometrioma on fertility. STUDY DESIGN: For 117 infertile women who were diagnosed as having endometriosis by laparoscopy and who underwent danazol therapy, we examined (1) the relationship between ovarian endometrioma and level of bead-phagocytotic macrophages in ascites and the interleukin-1 beta level, (2) the relationship between ovarian endometrioma and pregnancy rate during the 36 months after danazol therapy, and (3) the relationship between ovarian endometrioma and pregnancy rate, considering the severity of the lesion on the bilateral tubes and the pelvic peritoneum. RESULTS: (1) The levels of bead-phagocytotic macrophages in patients with or without ovarian endometrioma were 68% and 67%, respectively (not significant). Similarly, no significant difference was seen in the interleukin-1 beta positive rate between the two groups. (2) The pregnancy rates of the former group and the latter group were 36% and 43%, respectively (not significant). (3) The existence or absence of ovarian endometrioma made no significant difference in the pregnancy rate in a group of patients with no lesions in the bilateral tubes or in another group with no lesions and scattered endometriotic implants on the peritoneum. CONCLUSIONS: It seems unlikely that ovarian endometrioma itself significantly impedes fertility after danazol therapy.

ABSTRACT

PIP In Japan, physicians prescribed 300-400 mg danazol to 117 women, 21-37 years old, diagnosed with endometriosis and followed them for 3 years. Prior to danazol therapy, laparoscopy had identified ovarian endometriosis in at least 1 ovary in 86% of the 49 patients. Danazol therapy resolved only 1 of these ovarian endometrioma cases. The 3-year pregnancy rates of women with and without ovarian endometrioma were not significantly different (36% vs. 43%). Even when the researchers compared endometriosis cases with completely intact tubes and with a completely intact pelvic peritoneum or with scattered endometriotic implants on the peritoneum, the absence or existence of ovarian endometrioma did not affect the pregnancy rate. The researchers compared the bead-phagocytotic macrophage activity of 34 women with endometriosis with that of 20 controls and found a significantly higher level among endometriosis cases than controls (66% vs. 34%; p .01). The activity level was not significantly different, however, between those with and without ovarian endometrioma (68% vs. 67%). The interleukin-1 beta positive rate in 53 endometriosis cases was significantly higher than it was in the 29 control cases (36% vs. 7%; p .01). It was the same in cases with ovarian endometrioma and those without ovarian endometrioma, however (36% for both groups). These results suggest that ovarian endometrioma itself does not impede conception after danazol therapy.