{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T16:25:04Z","timestamp":1792686304634,"version":"4.5.0"},"reference-count":27,"publisher":"Public Library of Science (PLoS)","issue":"8","license":[{"start":{"date-parts":[[2022,8,3]],"date-time":"2022-08-03T00:00:00Z","timestamp":1659484800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003196","name":"Ministero della Salute","doi-asserted-by":"publisher","award":["ENDO-2020-23670289"],"award-info":[{"award-number":["ENDO-2020-23670289"]}],"id":[{"id":"10.13039\/501100003196","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:p>The management of endometriosis-related infertility is still a challenging issue. Women can be managed with either surgery or in vitro fertilization (IVF). The decision is tailored to the patients considering pros and cons of both approaches. Surgery might increase the chances of natural conception and relieve symptoms. IVF may be more effective, but costs are higher and unoperated women face some peculiar additional risks during the procedure and pregnancy. The unavailability of randomized trials comparing the two strategies hampers the possibility to provide precise estimates. This Randomized Controlled Trial (RCT) aims at filling this gap. This is a multicenter, non-blinded, randomized controlled trial with parallel groups and allocation 1:1. Three Italian Academic Infertility Units will be involved. Main inclusion criteria are infertility for more than one year, age less than 40 years and a sonographic diagnosis of endometriosis (ovarian endometriomas or deep peritoneal lesions). Previous IVF and previous surgery for endometriosis are exclusion criteria. Women will be randomized to either surgery and then natural pregnancy seeking or a standard program of three IVF cycles. The primary aim is the comparison of live birth rate between the two groups (IVF versus surgery) within one year of randomization. The secondary aim is the evaluation of cost-effective profile of the two interventions. The present study can influence the clinical practice of infertility treatment in women with endometriosis. From a public health perspective, information on the more cost-effective clinical management strategy would consent a wiser allocation of resources.<\/jats:p>\n                  <jats:p>\n                    <jats:bold>Trial registration:<\/jats:bold>\n                    <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/clinicaltrials.gov\/ct2\/show\/NCT04743167\" xlink:type=\"simple\">NCT04743167<\/jats:ext-link>\n                    , registered on 8 February 2021.\n                  <\/jats:p>","DOI":"10.1371\/journal.pone.0271173","type":"journal-article","created":{"date-parts":[[2022,8,3]],"date-time":"2022-08-03T13:35:36Z","timestamp":1659533736000},"page":"e0271173","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":19,"title":["Surgery versus IVF for the treatment of infertility associated to ovarian and deep endometriosis (SVIDOE: Surgery Versus IVF for Deep and Ovarian Endometriosis). Clinical protocol for a multicenter randomized controlled trial"],"prefix":"10.1371","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3798-7342","authenticated-orcid":true,"given":"Jessica","family":"Ottolina","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michele","family":"Vignali","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Enrico","family":"Papaleo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paola","family":"Vigan\u00f2","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edgardo","family":"Somigliana","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefano","family":"Ferrari","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valeria","family":"Liprandi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gaia","family":"Belloni","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Reschini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Massimo","family":"Candiani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paolo","family":"Vercellini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Benaglia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2022,8,3]]},"reference":[{"key":"pone.0271173.ref001","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1038\/nrendo.2013.255","article-title":"Endometriosis: pathogenesis and treatment","volume":"10","author":"P Vercellini","year":"2014","journal-title":"Nat Rev Endocrinol"},{"key":"pone.0271173.ref002","first-page":"31","article-title":"Management of Endometriosis in the Infertile Patient","volume":"35","author":"E Somigliana","year":"2017","journal-title":"Semin Reprod Med."},{"key":"pone.0271173.ref003","doi-asserted-by":"crossref","first-page":"374","DOI":"10.1016\/j.fertnstert.2019.09.031","article-title":"Interventions for endometriosis-related infertility: a systematic review and network meta-analysis","volume":"113","author":"RM Hodgson","year":"2020","journal-title":"Fertil Steril"},{"key":"pone.0271173.ref004","first-page":"CD011031","article-title":"Laparoscopic surgery for endometriosis","volume":"10","author":"C Bafort","year":"2020","journal-title":"Cochrane Database Syst Rev"},{"key":"pone.0271173.ref005","doi-asserted-by":"crossref","first-page":"hoz009","DOI":"10.1093\/hropen\/hoz009","article-title":"When more is not better: 10 \u2019don\u2019ts\u2019 in endometriosis management. An ETIC* position statement","volume":"2019","author":"ETIC Endometriosis Treatment Italian Club","year":"2019","journal-title":"Hum Reprod Open"},{"key":"pone.0271173.ref006","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1016\/j.jmig.2020.07.014","article-title":"Fertility Outcome after CO2 Laser Vaporization versus Cystectomy in Women with Ovarian Endometrioma: A Comparative Study","volume":"28","author":"M Candiani","year":"2021","journal-title":"J Minim Invasive Gynecol"},{"key":"pone.0271173.ref007","doi-asserted-by":"crossref","first-page":"29","DOI":"10.5653\/cerm.2013.40.1.29","article-title":"Natural conception rate following laparoscopic surgery in infertile women with endometriosis","volume":"40","author":"HJ Lee","year":"2013","journal-title":"Clin Exp Reprod Med"},{"key":"pone.0271173.ref008","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1055\/s-0032-1333478","article-title":"Role of surgery in endometriosis-associated subfertility","volume":"31","author":"N Berlanda","year":"2013","journal-title":"Semin Reprod Med"},{"key":"pone.0271173.ref009","doi-asserted-by":"crossref","first-page":"486","DOI":"10.1093\/humupd\/dmv012","article-title":"Risks of conservative management in women with ovarian endometriomas undergoing IVF","volume":"21","author":"E Somigliana","year":"2015","journal-title":"Hum Reprod Update"},{"issue":"11","key":"pone.0271173.ref010","doi-asserted-by":"crossref","first-page":"4215","DOI":"10.1210\/jc.2015-2474","article-title":"Is Anti-M\u00fcllerian Hormone Associated With Fecundability? Findings From the EAGeR Trial","volume":"100","author":"SM Zarek","year":"2015","journal-title":"J Clin Endocrinol Metab"},{"issue":"14","key":"pone.0271173.ref011","doi-asserted-by":"crossref","first-page":"1367","DOI":"10.1001\/jama.2017.14588","article-title":"Association Between Biomarkers of Ovarian Reserve and Infertility Among Older Women of Reproductive Age","volume":"318","author":"AZ Steiner","year":"2017","journal-title":"JAMA"},{"key":"pone.0271173.ref012","volume-title":"Laboratory manual examination of human semen and semen cervical mucus interaction","year":"2010"},{"key":"pone.0271173.ref013","doi-asserted-by":"crossref","first-page":"318","DOI":"10.1002\/uog.15955","article-title":"Systematic approach to sonographic evaluation of the pelvis in women with suspected endometriosis, including terms, definitions and measurements: a consensus opinion from the International Deep Endometriosis Analysis (IDEA) group","volume":"48","author":"S Guerriero","year":"2016","journal-title":"Ultrasound Obstet Gynecol"},{"issue":"3","key":"pone.0271173.ref014","doi-asserted-by":"crossref","first-page":"284","DOI":"10.1002\/uog.14806","article-title":"Terms, definitions and measurements to describe sonographic features of myometrium and uterine masses: a consensus opinion from the Morphological Uterus Sonographic Assessment (MUSA) group","volume":"46","author":"T Van den Bosch","year":"2015","journal-title":"Ultrasound Obstet Gynecol."},{"key":"pone.0271173.ref015","doi-asserted-by":"crossref","first-page":"1609","DOI":"10.1016\/j.fertnstert.2009.09.035","article-title":"Endometriosis fertility index: the new, validated endometriosis staging system","volume":"94","author":"GD Adamson","year":"2010","journal-title":"Fertil Steril"},{"issue":"1","key":"pone.0271173.ref016","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1016\/j.rbmo.2018.03.020","article-title":"Oocyte retrieval difficulties in women with ovarian endometriomas","volume":"37","author":"L Benaglia","year":"2018","journal-title":"Reprod Biomed Online"},{"issue":"3","key":"pone.0271173.ref017","doi-asserted-by":"crossref","first-page":"283.e1","DOI":"10.1016\/j.ajog.2021.04.234","article-title":"Single oral dose of vitamin D3 supplementation prior to in vitro fertilization and embryo transfer in normal weight women: the SUNDRO randomized controlled trial","volume":"225","author":"E Somigliana","year":"2021","journal-title":"Am J Obstet Gynecol."},{"issue":"9","key":"pone.0271173.ref018","doi-asserted-by":"crossref","first-page":"2463","DOI":"10.1093\/humrep\/deab160","article-title":"Is a freeze-all policy the optimal solution to circumvent the effect of late follicular elevated progesterone? A multicentric matched-control retrospective study analysing cumulative live birth rate in 942 non-elective freeze-all cycles","volume":"36","author":"A Racca","year":"2021","journal-title":"Hum Reprod"},{"issue":"11","key":"pone.0271173.ref019","doi-asserted-by":"crossref","first-page":"1773","DOI":"10.1111\/jog.12830","article-title":"Surgical excision of ovarian endometriomas: Does it truly impair ovarian reserve? Long term anti-M\u00fcllerian hormone (AMH) changes after surgery","volume":"41","author":"M Vignali","year":"2015","journal-title":"J Obstet Gynaecol Res"},{"issue":"2","key":"pone.0271173.ref020","first-page":"CD009591","article-title":"Imaging modalities for the non-invasive diagnosis of endometriosis","volume":"2","author":"V Nisenblat","year":"2016","journal-title":"Cochrane Database Syst Rev."},{"key":"pone.0271173.ref021","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1186\/s12905-015-0248-4","article-title":"\"You can\u2019t always get what you want\": from doctrine to practicability of study designs for clinical investigation in endometriosis","volume":"15","author":"P Vercellini","year":"2015","journal-title":"BMC Womens Health"},{"key":"pone.0271173.ref022","doi-asserted-by":"crossref","first-page":"393","DOI":"10.1016\/j.rbmo.2019.12.006","article-title":"Is early initiation of infertility treatment justified in women over the age of 35 years?","volume":"40","author":"E Somigliana","year":"2020","journal-title":"Reprod Biomed Online"},{"key":"pone.0271173.ref023","article-title":"Does AMH relate to timing of menopause? Results of an Individual Patient Data meta- analysis","author":"M Depmann","year":"2018","journal-title":"J Clin Endocrinol Metab"},{"key":"pone.0271173.ref024","doi-asserted-by":"crossref","first-page":"1307","DOI":"10.1111\/aogs.12761","article-title":"Serum anti-M\u00fcllerian hormone in subfertile women","volume":"94","author":"E Somigliana","year":"2015","journal-title":"Acta Obstet Gynecol Scand"},{"key":"pone.0271173.ref025","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1016\/j.ejogrb.2017.04.003","article-title":"Impact of large ovarian endometriomas on the response to superovulation for in vitro fertilization: A retrospective study","volume":"213","author":"S Ferrero","year":"2017","journal-title":"Eur J Obstet Gynecol Reprod Biol."},{"issue":"2","key":"pone.0271173.ref026","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1016\/j.rbmo.2020.03.003","article-title":"The impact of endometrioma size on ovarian responsiveness","volume":"41","author":"E Somigliana","year":"2020","journal-title":"Reprod Biomed Online"},{"issue":"3","key":"pone.0271173.ref027","doi-asserted-by":"crossref","first-page":"400","DOI":"10.1093\/humrep\/det457","article-title":"European Society of Human Reproduction and Embryology. ESHRE guideline: management of women with endometriosis","volume":"29","author":"GA Dunselman","year":"2014","journal-title":"Hum Reprod"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0271173","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,8,3]],"date-time":"2022-08-03T13:35:58Z","timestamp":1659533758000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0271173"}},"subtitle":[],"editor":[{"given":"James","family":"Mockridge","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2022,8,3]]},"references-count":27,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2022,8,3]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0271173","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,8,3]]}}}