Embryo Euploidy Rates and Reproductive Outcomes Following Ethanol Sclerotherapy, Laparoscopic Cystectomy, or No Intervention for Ovarian Endometriomas Prior to IVF with PGT-A: A Retrospective Cohort Study

Study Objective To compare embryo euploidy rates and reproductive outcomes among women with ovarian endometriomas who underwent ethanol sclerotherapy (EST), laparoscopic cystectomy, or expectant management prior to in vitro fertilization (IVF) with preimplantation genetic testing for aneuploidy (PGT-A). Design Retrospective cohort study. Setting Tertiary referral center. Participants 554 infertile women with ovarian endometriomas (≥3 cm) who underwent IVF with PGT-A. Interventions EST (n=67), laparoscopic cystectomy (n=138), or no intervention (n=349). Measurements and Main Results The primary outcome was blastocyst euploidy rate. Secondary outcomes included cumulative live birth rate (CLBR) and clinical pregnancy rate. Baseline characteristics were comparable, except for larger endometrioma size (p<0.001) and higher prevalence of severe endometriosis (p=0.013) in the EST group. Euploidy rates did not differ significantly (p=0.129). CLBRs were 37.3%, 27.5%, and 30.1% in the EST, cystectomy, and no-intervention groups, respectively (p=0.356). Multivariable and propensity score-matched analyses confirmed that the treatment group was not significantly associated with euploidy rate, CLBR, or clinical pregnancy. Conclusion Endometrioma management strategy does not significantly influence embryo euploidy rates or reproductive outcomes in women undergoing IVF with PGT-A. The choice of pre-IVF endometrioma management may be guided by clinical considerations other than concerns regarding embryo chromosomal competence.