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Abstract：
Controversy exists regarding surgical management of endometriomas in infertile women before in vitro fertilization (IVF) because growing evidence indicates that surgery may impair the ovarian response. The objective of the present systematic review and meta-analysis was to compare surgical and expectant management of endometriomas regarding IVF outcomes. Prospective and retrospective controlled studies were found via the Cochrane Library, Embase, and MEDLINE databases. Thirteen studies (1 randomized controlled trial and 12 observational studies, N = 2878) were pooled, and similar live birth rates were observed in the surgically and expectantly managed groups (odds ratio = 0.83; 95% confidence interval [CI], 0.56-1.22; p = .98). The clinical pregnancy rates (odds ratio = 0.83; 95% CI, 0.66-1.05; p = .86), the number of mature oocytes retrieved, and the miscarriage rates were not statistically different between study groups. However, the total number of oocytes retrieved was lower in the surgery group (mean difference = -1.51; 95% CI, -2.60 to -0.43; p = .02). Findings suggest that surgical management of endometriomas before IVF therapy yields similar live birth rates as expectant management. However, future properly designed randomized controlled trials are warranted.
摘要：
由于越来越多的证据表明手术可能会损害卵巢反应，因此在体外受精（IVF）之前，不孕妇女子宫内膜瘤的手术治疗存在争议。本系统综述和荟萃分析的目的是比较子宫内膜瘤的手术和预期治疗与IVF结局的关系。通过Cochrane图书馆发现了前瞻性和回顾性对照研究，Embase,和MEDLINE数据库。13项研究(1项随机对照试验和12项观察性研究，N=2878)合并，在手术和预期管理的组中观察到相似的活产率(比值比=0.83;95%置信区间[CI],0.56-1.22；p=.98）。临床妊娠率（比值比=0.83；95%CI，0.66-1.05；p=0.86），回收的成熟卵母细胞的数量，研究组之间的流产率无统计学差异.然而,手术组的卵母细胞总数较低(平均差=-1.51;95%CI,-2.60至-0.43;p=.02).研究结果表明，IVF治疗前子宫内膜瘤的手术治疗产生的活产率与预期治疗相似。然而,未来有必要进行适当设计的随机对照试验.
