The Endometrioma Treatment Paradigm when Fertility Is Desired: A Systematic Review

Charles E. Miller
Journal of Minimally Invasive Gynecology · 2020 · vol. 28(3) , pp. 575–586 · doi:10.1016/j.jmig.2020.11.020 · PMID:33249267 · W3107377634
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⚙ AI-generated summary by claude@2026-06, 2026-06-07 ⓘ

This systematic review analyzes current treatments for endometriomas when fertility is a primary concern for patients.

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Abstract

ObjectiveTo establish an endometrioma treatment paradigm (decision tree) in the treatment of an ovarian endometrioma through the review of current literature.Data sourcesA thorough literature search, including PubMed, Google Scholar, and the Cochrane Library, was performed from April 2020 to July 2020. The review was completed by using the following keywords: METHODS OF STUDY SELECTION: Articles published in English that addressed the endometrioma in regard to the following were included: (1) diagnosis, (2) treatment of pain on the basis of size and/or surgical intervention, (3) treatment of fertility on the basis of size and/or surgical intervention, (4) surgical technique, (5) in vitro fertilization success on the basis of size and/or surgical intervention, (6) risk of rupture at the time of egg retrieval, (7) impact on the antimüllerian hormone and antral follicle count postsurgery, and (8) impact on implantation.Tabulation, integration, and resultsFifty-six articles were included in this systematic review. While conducting this literature review, several themes were noted. In general, the literature on the ovarian endometrioma seems to be homogeneous in regard to imaging the endometrioma, excision rather than desiccation for an endometrioma ≥3-cm causing pain and/or infertility, minimal use of bipolar energy at the time of ovarian surgery, and risk of severe infection secondary to inadvertent rupture of cysts during egg retrieval. Conversely, studies on the ovarian endometrioma are much more heterogeneous in terms of surgery and assisted reproductive technology, that is, whether surgery should be performed. Certainly, an endometrioma ≥5-cm should be excised before assisted reproductive technology. Moreover, it seems that the antral follicle count and implantation may be enhanced with surgery.ConclusionBy completing an extensive literature review, an easy-to-use algorithm for the diagnosis, evaluation, and treatment of endometriomas was developed to help clinicians in their treatment of patients with endometriosis in the short and long terms.

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Condition tags

endometriosisendometrioma

MeSH descriptors

Endometriosis Fertility Preservation Fertilization in Vitro Gynecologic Surgical Procedures Infertility, Female Endometriosis Female Fertility Preservation Fertilization in Vitro Gynecologic Surgical Procedures Humans Infertility, Female

Citation neighborhood

Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. [ expand to 2 hops ] — adds papers reached through this work's immediate citers/citees. Heavier; up to 60 extra dots.

References (59)

Cited by (17)

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