***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE To investigate whether aspiration of ovarian endometriomas before controlled ovarian stimulation ( COH ) improves intracytoplasmic sperm injection ( ICSI ) outcomes . DESIGN Prospect i ve study . SETTING University hospital . PATIENT(S ) A prospect i ve analysis of 171 patients with ovarian endometriosis and tubal factor infertility were divided into four groups : aspiration of endometriomas at the beginning of COH in patients with ovarian endometriomas and no history of previous surgery ( n = 41 ) ( group 1 ) ; nonaspirated endometriomas ( n = 40 ) ( group 2 ) ;  history of ovarian surgery for endometriomas in patients without ovarian endometriomas at the beginning of COH ( n = 44 ) ( group 3 ) ; and  tubal factor infertility ( n = 46 ) ( control group 4 ) . INTERVENTION(S ) Aspiration of endometriomas . MAIN OUTCOME MEASURE(S ) Clinical parameters , characteristics of COH , and ICSI results were analyzed . RESULT ( S ) We observed higher levels of E(2 ) on the day of hCG injection after aspiration of endometriomas compared with nonaspirated endometriomas . When we compared all endometriomas and tubal factor ( control ) groups , we observed a lower number of total follicles ( > 17 mm ) and metaphase II ( MII ) oocytes in nonaspirated and resected endometrioma groups and a longer duration of COH in the nonaspirated endometrioma group compared with the tubal factor group . Implantation and clinical pregnancy rates were similar among all groups . CONCLUSION ( S ) In the current study , all patients with endometriomas had significantly lower numbers of MII oocytes compared with those in patients with tubal factor infertility . We propose that aspiration of endometriomas before COH neither reduces the amount of gonadotropins nor increases the number of follicles > 17 mm , the number of MII oocytes retrieved , the implantation rates , or the clinical pregnancy rates . Resection of small endometriomas ( 1 - 6 cm ) may not present any additional benefits to the IVF-ICSI cycle outcomes Background To evaluate the impact of the presence of endometrioma and laparoscopic cystectomy on ovarian reserve as assessed by serum anti-Müllerian hormone ( AMH ) level . In addition , factors related to the decline in ovarian reserve were analyzed . Methods From June 2013 to January 2014 , we prospect ively included 40 women with endometriomas as the study group ( group A ) , 36 women with tubal factor infertilities as control group 1 ( group B ) and 22 women with the other benign ovarian cysts as control group 2 ( group C ) . The women with ovarian cysts underwent laparoscopic cystectomy .  Serum AMH levels were determined preoperatively and at 1 month after surgery . Results The endometrioma group had lower AMH levels ( 1.53 ± 1.37 ng/ml ) compared with the other benign ovarian cyst group ( 2.20 ± 1.23 ng/ml ) and the tubal factor infertility group ( 2.82 ± 1.74 ng/ml ) . The rate of serum AMH decline 1 month after surgery in the endometrioma group ( 0.62 ± 0.35 ) was larger than the decline in the other benign ovarian cyst group ( 0.32 ± 0.30 ) . The preoperative AMH level showed a significant correlation with patient age ( group A , r = −0.32 ; group B , r = −0.54 ; group C , r = −0.71 ) ; there was a statistically significant correlation between the rate of serum AMH decline and endometrioma diameter as well as with the preoperative serum AMH level . In addition , the rate of serum AMH decline was larger for bilateral endometriomas than for unilateral endometriomas , but there was no similar correlation in the other benign ovarian cyst group . The rate of AMH decline after surgery in the subgroup of > 7 cm was significantly higher than in the subgroup of ≤7 cm . Conclusions Ovarian endometriomas per se may damage ovarian reserve , and cystectomy of endometriomas may cause greater damage to ovarian reserve compared with other benign ovarian cysts . The operation-related damage to the ovarian reserve was positively related to whether the endometriomas were bilateral , as well as cyst size ( especially for cysts > 7 cm ) , but was negatively related to the preoperative serum AMH level . Age was a negative factor that affected the ovarian reserve We investigated the relationship between oxidative stress and poor oocyte quality  and whether the antioxidant melatonin improves oocyte quality . Follicular fluid was sample d at oocyte retrieval during in vitro fertilization and embryo transfer ( IVF-ET ) . Intrafollicular concentrations of 8-hydroxy-2'-deoxyguanosine ( 8-OHdG ) in women with high rates of degenerate oocytes were significantly higher than those with low rates of degenerate oocytes . As there was a negative correlation between intrafollicular concentrations of 8-OHdG and melatonin , 18 patients undergoing IVF-ET were given melatonin ( 3 mg/day ) , vitamin E ( 600 mg/day ) or both melatonin and vitamin E.  Intrafollicular concentrations of 8-OHdG and hexanoyl-lysine adduct were significantly reduced by these antioxidant treatments . One hundred and fifteen patients who failed to become pregnant with a low fertilization rate ( < or = 50 % ) in the previous IVF-ET cycle were divided into two groups during the next IVF-ET procedure ; 56 patients with  melatonin treatment  ( 3 mg/day ) and 59 patients without melatonin treatment . The fertilization rate was improved by melatonin treatment compared to the previous IVF-ET cycle . However , the fertilization rate was not significantly changed without melatonin treatment . Oocytes recovered from preovulatory follicles in mice were incubated with H2O2 for 12 hr . The percentage of mature oocytes with a first polar body was significantly reduced by addition of H2O2 ( 300 microm ) . The inhibitory effect of H2O2 was significantly blocked by simultaneous addition of melatonin . In conclusion , oxidative stress causes toxic effects on oocyte maturation and melatonin protects oocytes from oxidative stress . Melatonin is likely to improve oocyte quality and fertilization rates OBJECTIVE To evaluate the adverse effects of endometriomas on ovarian reserve . DESIGN Analysis of prospect ively collected biopsy sample s. SETTING Gynecology research unit in a university hospital . PATIENT(S ) Women younger than age 35 years with endometriomas . INTERVENTION(S ) Biopsy of normal cortex from ovaries affected by endometriomas ( ≤4 cm ) and contralateral ovaries without cysts . MAIN OUTCOME MEASURE(S ) Presence of cortex-specific stroma , observation of superficial endometriosis , follicular density , and presence of fibrosis . RESULT ( S ) Twenty sample s of cortical tissue from ovaries with endometriomas and 11 from contralateral ovaries without cysts were analyzed . Follicular density was significantly lower in cortex from ovaries with endometriomas than in cortex from contralateral ovaries without cysts ( mean ± SD = 6.3 ± 4.1/mm(3 ) vs 25.1 ± 15.0/mm(3 ) ) . Eleven ( 55 % ) cortical sample s from ovaries with endometriomas showed fibrosis and concomitant loss of cortex-specific stroma , not observed in contralateral normal ovaries . Multivariate analysis revealed that the presence of endometrioma and fibrosis were significantly and independently associated with follicular density . CONCLUSION ( S ) Endometriotic cyst formation and associated structural tissue alterations in apparently normal ovarian cortex may be a cause of reduced ovarian reserve . Early diagnosis and intervention may be beneficial in women with endometriomas to protect their ovarian function OBJECTIVE To evaluate the effects of laparoscopic cystectomy on ovarian reserve in patients with endometriomas . DESIGN Prospect i ve study . SETTING Private and university hospitals . PATIENT(S ) A total of 193 patients with endometriomas undergoing laparoscopic cyctectomy .  INTERVENTION(S ) Serum levels of antimüllerian hormone ( AMH ) , FSH , and E₂ , as well as antral follicle count ( AFC ) were measured preoperatively and 1 week , 3 and 9 months postoperatively for AMH , and 3 months for other values . MAIN OUTCOME MEASURE(S ) Ovarian reserve based on the comparison of AMH alterations . The secondary end points are changes in FSH , E₂ , and AFC . RESULT ( S ) Serum AMH level decreased significantly from the baseline ( 3.86 ± 3.58 ng/mL ) to 1 week ( 1.66 ± 1.92 ng/mL ) , 3 months ( 2.06 ± 2.5 ng/mL ) , and 9 months ( 1.77 ± 1.76 ng/mL ) postoperatively . Those patients with bilateral endometriomas had significantly lower levels of AMH , 1 week , 3 and 9 months after operation . Also , patients older than 38 years had lower postoperative AMH levels . The FSH levels increased significantly from baseline to 3 months postoperatively . The AFC level increased significantly from baseline to 3 months after operation . CONCLUSION ( S ) The AMH level decreased and the FSH level increased after laparoscopic cystectomy for endometriomas , especially in older patients and those with bilateral cysts OBJECTIVE To determine the difference between two laparoscopic methods for the management of endometriomas with regard to recurrence of signs and symptoms and pregnancy rate . DESIGN Prospect i ve , r and omized clinical trial . SETTING Infertility and gynecologic endoscopy units of two medical university hospitals . PATIENT(S ) One hundred patients with endometriomas who had either infertility or pelvic pain . INTERVENTION(S ) Patients were r and omly divided into two groups ; one group underwent cystectomy ( group 1 ) , and fenestration and coagulation were performed for the other ( group 2 ) . MAIN OUTCOME MEASURE(S ) A comparison of recurrence of signs and symptoms of endometriomas and pregnancy rates in two groups . RESULT ( S ) Fifty-two patients were studied in group 1 and 48 in group 2 . The recurrence of symptoms , such as pelvic pain and dysmenorrhea , was 15.8 % in group 1 and 56.7 % in group 2 after 2 years . The rate of reoperation was 5.8 % in group 1 and 22.9 % in group 2 and these differences were statistically significant . The cumulative pregnancy rate was significantly higher in group 1 ( 59.4 % ) than in group 2 ( 23.3 % ) at 1-year follow-up . CONCLUSION ( S ) Laparoscopic cystectomy of endometriomas is a better choice than fenestration and coagulation because the former technique leads to a lower recurrence of signs and symptoms and a lower rate of reoperation and a higher cumulative pregnancy rate than the latter OBJECTIVE Conventional treatment of endometriosis involves drainage and removal of the cyst wall , which often results in inadvertent resection of normal ovarian tissue . We previously reported that 12 patients were successfully treated with sclerotherapy  using 5 % tetracycline . We now report our experience with sclerotherapy before in vitro fertilization ( IVF ) in an additional 20 patients with ovarian endometriomas . DESIGN Prospect i ve , cohort . SETTING Private practice . PATIENT(S ) Women ( n = 32 ) with sonographic evidence of an ovarian endometrioma were offered sclerotherapy in lieu of laparoscopy . INTERVENTION(S ) Sclerotherapy was performed under conscious sedation and transvaginal ultrasound guidance . An 18-gauge , single-lumen needle was inserted into the endometrioma , and the cyst contents were sequentially aspirated and flushed with sterile saline until the aspirated fluid was clear . Tetracycline ( 5 % ) ( 5 - 10 mL ) was then instilled into the cyst . Saline was injected into the cul-de-sac to dilute any tetracycline that may have leaked . The fluid was then removed . Ultrasound was performed 6 weeks later to assess the efficacy of treatment . MAIN OUTCOME MEASURE(S ) Resolution of endometrioma and subsequent IVF pregnancy rate . RESULT ( S ) Complete resolution was observed in 24 ( 75 % ) of 32 patients , at follow-up exam . Repeat aspiration of watery fluid was required in eight patients before resolution . Repeat treatment with tetracycline was needed in two patients . Only one patient did not ultimately respond . In vitro fertilization was performed in 28 patients ; an ongoing gestation result ed in 16 ( 57 % ) from the next cycle . CONCLUSION ( S ) Sclerotherapy with 5 % tetracycline is a simple , effective ( and , in our limited series , safe ) alternative to surgical intervention for treatment of endometriomas before IVF The study was conducted to investigate the effect of conservative surgery of ovarian endometriomas before an ICSI cycle . Ninety-nine patients with endometriomas who were referred 
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Conclusion Treatments are usually based on the patient 's clinical condition and must be individual , with the purpose of relieving pain , improving fertility , or both .
The authors do not have not any significant difference between our four groups of study ; however , the success of surgical procedure compared to other methods was higher and the success of ART alone was the least