Dottorato in SCIENZE ENDOCRINOLOGICHE

Titolo della tesi: Impatto della stimolazione ovarica sulla dimensione degli endometriomi e sulle variabili ecografiche dell’adenomiosi durante l’IVF.

Abstract Background: Endometriosis and adenomyosis are two estrogen-dependent gynecological disorders that have a strong impact on patients’ quality of life and on society, as they are associated with symptoms such as chronic pain and infertility. Information regarding the growth and development of endometriomas and adenomyosis during in vitro fertilization (IVF) cycles is still limited. Aim: The aim of this study was to evaluate changes in endometrioma size and ultrasound features of adenomyosis during IVF treatment. Materials and Methods: In this retrospective study, we analyzed 37 patients with ovarian endometriomas and 14 patients with adenomyosis, all presenting with infertility and treated the Reproductive Physiology Unit of the Department of Maternal-Infant and Urological Sciences at Policlinico Umberto I in Rome, Italy, between January 2015 and June 2025. All patients underwent transvaginal ultrasound both at the beginning of the IVF cycle and after ovarian stimulation, in order to assess variations in endometrioma volume and in MUSA ultrasound criteria for adenomyosis. Some patients underwent up to three ovarian stimulations. Results: We observed a statistically significant increase in endometrioma volume (10.49 ml ± 11.02 ml vs. 15.82 ml ± 14.91 ml; p = 0.04), as well as a mean uterine volume increase of 24.5 ml (12.5%; p = 0.03). This increase was proportional to serum estrogen levels at the time of the trigger. No statistically significant changes were observed in the other MUSA ultrasound parameters for adenomyosis, nor in subsequent stimulation cycles. Conclusion: Our findings confirm existing evidence in the literature regarding the increase in ovarian endometrioma size after an IVF cycle, although this growth appears to be clinically negligible. To the best of our knowledge, no previous study has investigated the impact of multiple stimulation cycles on endometriomas size or the impact of IVF on adenomyosis. This may represent an innovative aspect of our work with potential implications for clinical practice. However, further studies are needed to draw definitive conclusions.