Evaluation of endometrioma size effect on IVF outcomes in young infertile women candidates for IVF cycle

Abstract Background Endometriomas are ovarian cysts associated with endometriosis, potentially impacting ovarian reserve and in vitro fertilization (IVF) outcomes. The effect of endometrioma size on IVF success remains controversial. This study aimed to evaluate the influence of endometrioma size on ovarian reserve parameters, oocyte and embryo quality, and pregnancy outcomes in infertile women undergoing IVF. Method This cross-sectional study included 57 infertile women with unilateral endometriomas undergoing IVF at Akbarabadi Hospital, Iran. Participants were divided into two groups based on endometrioma size: < 3 cm (n = 26) and ≥ 3 cm (n = 31). Ovarian reserve markers (AMH, AFC, FSH), oocyte and embryo quality, clinical pregnancy rate, and live birth rate were compared between groups. Statistical analyses were performed using SPSS 27. Result There were no significant differences between the two groups in age, BMI, duration of infertility, AMH, AFC, or FSH levels. Oocyte quality, embryo quality, and clinical pregnancy rates were also comparable (P > 0.05). However, a significantly lower live birth rate was observed in the ≥ 3 cm endometrioma group compared to the < 3 cm group (28.6% vs. 70.0%, P = 0.004). Conclusion Endometrioma size does not significantly affect ovarian reserve, oocyte retrieval, or early embryo development. However, larger endometriomas (≥ 3 cm) may be associated with a lower live birth rate, possibly due to inflammatory or mechanical effects. Further multicenter studies with larger sample sizes are needed to confirm these findings and optimize IVF strategies for women with endometriomas.