Original Article Reproductive Outcomes of Segmented In Vitro Fertilization in Patients Diagnosed with Endometriomas Kemal Ozgur, MD, Hasan Bulut, MD, Murat Berkkanoglu, MD, and Kevin Coetzee, PhD From the Antalya IVF Clinic, Antalya, Turkey (all authors). ABSTRACT Study Objective: To assess the impact of ovarian endometriomas on endometrial receptivity in frozen embryo transfer (FET) of segmented in vitro fertilization (IVF) cycles. Design: Retrospective, matched-control study (Canadian Task Force classification II-2). Setting: A single, private assisted-reproduction technology center. Patients: Thirty patients diagnosed with unilateral or bilateral endometriomas were compared with 60 patients without en- dometriomas in a population of 1894 patients who underwent segmented IVF treatment between September 2014 and September 2016. Intervention: Intracytoplasmic sperm injection with blastocyst freeze-all and FET. Measurements and Main Results: The primary endpoint of the study was a viable pregnancy (>14 weeks). The mean di- ameter of diagnosed endometriomas was 25.7 ± 10.6 mm. The median antral follicle count was significantly lower in the endometrioma group compared with the entire study population (11.5; interquartile range [IQR], 6.0–17.0 vs 14.0; IQR, 9.0–22.0; p = .042). The median number of mature ovarian follicles (≥14 mm) per antral follicle that developed during con- trolled ovarian stimulation was not significantly different between the groups (11.0 [IQR, 5.8–14.3] vs 10.0 [IQR, 6.0– 15.8]; p = .908); however, the median number of oocytes retrieved was lower in the endometrioma group (11.5 [IQR, 6.0– 21.5] vs 13.5 [IQR, 9.0–20.8]; p = .373). The biochemical pregnancy, implantation, and ongoing pregnancy rates were not significantly different between the endometrioma and control groups. Conclusion: Although ovarian endometriomas result in reduced ovarian reserve and oocyte retrieval, their impact on re- productive outcome is limited with FET. Journal of Minimally Invasive Gynecology (2018) 25, 105–110 © 2017AAGL. All rights reserved. Keywords: Antral follicle count; Endometrioma; Freeze-all; Frozen embryo transfer; Ovarian reserve Endometriosis is defined by the presence of endometrial tissue growing outside the uterus, most commonly on the ovary and in the peritoneum, resulting in inflammation, adhesions, distortions of the pelvic anatomy, and infertility [1]. An ovarian endometrioma is a pseudo-ovarian cystic mass [2] that is easily distinguished from other cysts because of its specific echogenic appearance [3,4]. Endometriosis is common (10%–15%) in women of reproductive age [5], with endometrioma found in 18% to 48% of women with endometriosis [6,7]. Ovarian en- dometrioma is generally regarded as a more severe stage of endometriosis [2]. Although some women with endome- trioma are asymptomatic, the majority experience pelvic pain, dysmenorrhea, dyspareunia, and infertility. Even though published guidelines for treatment exist [1], controversy remains regarding the best treatment for infer- tile women with endometrioma [6,8,9], specifically regarding surgical excision prior to assisted reproductive treatment [2,9,10]. Surgical excision of large endometriomas (>30– 40 mm) has been shown to relieve nonmenstrual and menstrual pelvic pain, diminish menstrual cycle dysfunction, and improve quality of life [2,11–13], but has not been shown to neces- sarily improve reproductive outcomes [2,8–10,13–15]. Because evidence has shown that endometriomas do not negatively impact reproductive outcomes of in vitro fertilization (IVF) and surgery might not improve the reproductive outcomes of IVF, some clinicians have been more inclined to recom- mend that patients undergo IVF without previous surgery [2,9,14]. The aim of the present study was to assess the impact of endometrioma on the reproductive outcomes of segmented IVF, with blastocyst transfer performed in frozen embryo trans- fer (FET) cycles subsequent to oocyte retrieval cycles. Corresponding author: Kevin Coetzee, PhD, Antalya IVF, Halide Edip Cd. 7, Kanal Mh., Antalya 07080, Turkey. E-mail: kevincoetzee61@yahoo.co.nz Submitted May 10, 2017. Accepted for publication June 20, 2017. Available at www.sciencedirect.com and www.jmig.org 1553-4650/$ — see front matter © 2017 AAGL. All rights reserved. https://doi.org/10.1016/j.jmig.2017.06.030