The ENDOCAN-1 trial evaluated which surgical approach for Stage III–IV endometriosis before IVF?
- A Laparoscopic surgery for endometrioma before IVF did not improve IVF outcomes and reduced ovarian reserve ✓
- B Laparoscopic resection of deep infiltrating endometriosis improved IVF live birth rates significantly
- C Medical suppression with GnRH agonist for 3 months before IVF improved pregnancy outcomes
- D Laparoscopic surgery for deep endometriosis improved pain but did not alter IVF live birth rates
Correct answer: A. Laparoscopic surgery for endometrioma before IVF did not improve IVF outcomes and reduced ovarian reserve
Explanation
Multiple RCTs and systematic reviews (including ENDOCAN-1) have shown that laparoscopic surgery for ovarian endometrioma before IVF does not improve live birth rates and may harm ovarian reserve by removing healthy ovarian cortex along with the cyst wall. The current ESHRE 2022 guidelines recommend against routine surgery for endometriomas < 4 cm before IVF. For larger endometriomas (≥ 4 cm) or when diagnosis is needed, surgery may be considered, balancing reserve reduction against potential benefits.
Reference: Shaw's Textbook of Gynaecology, 17th ed.
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