Conservative management versus aspiration of functional ovarian CYSTS following long acting GNRH- analog before ovarian stimulation in assisted reproduction

Abstract EN

Objective : to compare the efficiency of transvaginal ultrasound-guided functional ovarian cyst aspiration, with conservative management, in the outcome of patients undergoing IVF / ICSI.

These cysts were identified before ovarian stimulation begun after administration of a midluteal GnRH agonist.

Design : prospective Case-control study Setting: Assisted Reproduction Technology Unit, International Islamic Center for Population Studies & Research, Al-Azhar University.

Methods : women who underwent IVF/ICSI cycle with a long protocol, and developed ovarian cysts, were randomly divided into a cyst aspiration group (n =71) in which the cysts were aspirated after diagnosis and a no intervention group (n = 43) for which the conservative treatment was continued following cyst diagnosis.

Main Outcome Measures : number of follicles, estradiol level and endometrial thickness on the day of hCG administration, number of HMG ampoules used, number of oocytes retrieved, embryo quality, clinical pregnancy and miscarriage rates.

Results : HMG ampoules consumption and days of HMG stimulation were significantly higher among the aspiration group than the no- intervention group (39.4 ± 7.8 vs.

.30.3 ± 8.3, P < 0.01 and 14.7 ± 1.2 vs.

12.4 ± 1.7, p < 0.05, respectively).

The cycle cancellation rate was also significantly higher in the aspiration group on the other hand, no difference between the numbers of oocytes retrieved, embryos quality, the incidence of pregnancy and miscarriage rate between the two groups.

Conclusion : cyst aspiration and conservative management showed similar number of oocytes retrieved, embryos quality, the incidence of pregnancy and miscarriage rate, in patients who develop functional ovarian cysts after pituitary down regulation following luteal phase gonadotropin-releasing hormone agonist administration.

Because cyst aspiration requires anesthesia, extra cost and stress, it would be wise to treat patients with such ovarian cysts conservatively and without any further intervention.