Recurrent endometrioma in infertile patients has worse outcome than primary endometrioma in response to controlled ovarian hyperstimulation and intrauterine insemination

Objective: To investigate the difference in the effectiveness of controlled ovarian hyperstimulation and intrauterine insemination (COH + IUI) on pregnancy rates in patients with primary and recurrent endometriomas. Study Design: Multicenter, retrospective cohort study done in 3 tertiary referral centers. Included in the study were (1) primary infertility patients with endometriomas who had no other probable cause for infertility, (2) those who underwent 2 cycles of COH + IUI, provid- ed the sperm test was nor- mal, (3) those who had at least 1 patent fallopian tube, and (4) those whose ovarian reserve was normal with ovulatory cycles. Therapy for COH was hMG (menotropin) or recombinant follicle-stimulating hormone (follitropin alfa, beta) at 75 IU/d starting from day 3. Trigger was done by 5,000-10,000 human chorionic gonadotropin or choriogonadotropin alfa 250 mu g/0.5 mL when the dominant follicle size reached 18 mm. Results: The ongoing pregnancy rates in patients with primary endometrioma were 14.4% per patient and 8.06% per cycle. In patients with recurrent endometrioma, the ongoing pregnancy rates were 6.06% per patient and 3.4% per cycle. Ongoing pregnancy rates were significantly higher in patients with primary endometrioma than in recurrent endometrioma patients. CONCLUSION: COH + IUI may be recommended even before surgery for couples with primary endometriomas when there is no other infertility factor. COH + IUI treatment is not recommended for recurrent endometrioma patients.