Dados do Trabalho

Title

SURGERY VERSUS EXPECTANT MANAGEMENT FOR ENDOMETRIOMAS: WHAT IS THE BEST BEFORE IVF? SYSTEMATIC REVIEW WITH METANALYSIS

Objective

Evaluate if resection of endometriomas by stripping or cystectomy increases pregnancy and live births rates. Secondary outcomes include cancellation rate, fertilization rate and number of oocytes retrieved.

Methods

It is a review systematic with meta-analysis, with the results guided according to the Guideline
PRISMA. Data synthesis was tabulated in Microsoft Excel and statistical analysis by R Studio. Two reviewers performed the screening.

Results

Among 1518 articles were screened. Seven studies were included - a randomized clinical trial and six observational studies, mostly with moderate risk of bias. The odds ratio of pregnancy rate after surgery (compared with conservative treatment before IVF/ICSI) was 0.82 (95% CI 0.61 - 1.08, seven studies, I2 = 0% Tau 2 = 0, X 2 6 = 2.97), and for the live birth rate was 0.67 (95% CI 0.46 - 0.96, four studies, I 2 = 0, Tau 2 = 0 , X 2 3 = 0.41). The average difference in the number of oocytes retrieved between the two subgroups was -1.03 (95% CI -1.27 - -0.78, six studies, I 2 = 50%, CI 0%-80%; Tau 2 < 0.0001, X² 5 = 10.03).

Conclusion

The metanalisys showed no increase in the pregnancy rate after surgery and it showed a reduction in ovarian reserve and live birth rate. The number of oocytes retrieved and the live birth rate were higher in the conservative treatment. However, better quality studies are needed.

Keywords

in vitro fertilization, fertility, cystectomy, endometriosis

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