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Study Objective: Although cystectomy remains the gold standard for the surgical treatments of endometriomas, concerns about the negative effect on ovarian reserve are rising. Laser-CO 2 vaporization of endometriomas has shown encouraging data on ovarian reserve preservation, postoperative pregnancy rates, and recurrence. The aim of this study was to assess postoperative recurrence rate and pregnancy rate in patients with endometriomas managed by CO 2 fiber laser vaporization after at least 5 years following surgery., Design: Retrospective study., Setting: Italian tertiary center from October 2023 to February 2024., Patients: We included women aged >18 years who underwent laparoscopic CO 2 fiber laser vaporization for endometriomas. Age ≥40 years, previous ovarian surgery, previous salpingectomy or hysterectomy, negative histologic finding for endometriosis, or any findings of malignancy at histology were exclusion criteria., Intervention: Ovarian endometriomas were vaporized through laparoscopic CO 2 fiber laser. After surgery, patients were included in a surveillance program with periodic clinical follow-ups., Measurements and Main Results: Seventy-eight patients were included. The mean age was 33.2 ± 4.6 years, the basal anti-Müllerian hormone was 2.7 ± 1.9 ng/mL, and the median diameter of the endometriomas was 4 (3-5) cm. The median duration of follow-up was 72.5 months (67-84.5). After surgery, 65.5% (n = 36) of women with reproductive desire achieved a pregnancy, 55.6% spontaneously, and 44.4% through Assisted Reproduction Techniques, with a mean time to pregnancy of 17.7 ± 18.1 months. A Kaplan-Meier curve for the 7 patients who experienced an ipsilateral recurrence showed that the median time to recurrence was 26 months and the estimated rate of disease-free patients was 91.03% at 100 months (95% confidence interval 82.10%-95.62%)., Conclusion: CO 2 fiber laser vaporization is an effective and safe surgical treatment of ovarian endometriomas, combining the advantage of being an ovarian tissue-sparing technique with long-term postoperative recurrence rate comparable with that described in literature for the cystectomy., (Copyright © 2024 AAGL. Published by Elsevier Inc. All rights reserved.)

Background: Infertile women carrying ovarian endometriomas can be managed either with surgery or by in-vitro fertilization (IVF). The aim of this study was to compare ovarian responsiveness to controlled ovarian stimulation (COS) in assisted reproduction techniques (ART) in infertile women carrying small intact endometriomas and those managed by endometrioma cystectomy or CO2 fiber laser ablation., Methods: Retrospective case-control study of prospectively collected data including women underwent ART for endometriosis-related infertility. The study group consisted of infertile women undergoing endometriomas CO2 fiber laser vaporization before ART ("ART after laser CO2" group). Controls were infertile women with endometrioma managed by cystectomy before ART ("ART after cystectomy" group) and infertile women with small endometriomas undergoing ART as first approach ("ART only" group)., Results: Of the 86 included patients, 27 (31.4%) belonged to "ART after laser CO2" group, 37 (43%) to "ART after cystectomy" group and 22 (25.6%) to "ART only" group. Surgical groups had larger endometriomas than patients referred to "ART only" group. No between-groups differences were observed in terms of COS protocol, gonadotropins starting and total doses and length of COS. While women belonged to "ART after cystectomy" group had fewer recruited follicles (P=0.014), oocytes (P=0.042), MII oocytes (P=0.042) and formed embryos (P=0.004) compared to women of "ART only" group, no significant differences were found between patients of "ART only" group "ART after laser CO2" group. A greater number of good-quality embryos were observed in surgical groups. No between-groups differences were found in clinical pregnancy rates., Conclusions: Our results demonstrate encouraging findings on IVF/ICSI outcomes after laser CO2 endometrioma ablation in terms of both quantity and quality of developed embryos.

Background: Data about endometrioma ablation using energies with little thermal spread reported good results in terms of ovarian reserve and postoperative pregnancy rates. The aim of the present study was to assess the impact of one step CO2 fiber laser vaporization for endometrioma on subsequent controlled ovarian stimulation., Methods: This prospective observational cohort study included a consecutive series of infertile patients who have undergone CO2 fibre laser vaporization for endometrioma treatment. The primary endpoint was to assess the number of follicles per ovary growing during controlled ovarian stimulation. The secondary endpoints included the number of oocytes retrieved, the total number of embryos obtained and the cumulative clinical pregnancy rate per patient treated., Results: Twenty-six patients underwent assisted reproductive technology after surgery for endometriosis-related infertility. In unilateral operated ovaries at the end of controlled ovarian stimulation no significant differences emerged from comparison of total recruited follicles in the operated ovary and in the contralateral ovary (P=0.55). If considering only bilateral endometriomas, the number of recruited follicles at the end of controlled ovarian stimulation was similar in both operated ovaries (P=0.79). The number of cumulative clinical pregnancies was 15 (57.7%; 95% CI: 38.5-76.9%). When comparing women aged ≤35 years to those aged >35 years, controlled ovarian stimulation outcomes were significantly higher in the younger patients. Age at the time of assisted reproductive technology was the only independent predictor for follicular growth during ovarian hyperstimulation (95% CI: -1.27 to -0.116, P=0.027)., Conclusions: CO2 laser-treated endometrioma is associated with favorable reproductive assisted reproductive technology outcomes.