Endometrioma surgery and possibilities of early disease control

Vasilios Tanos, Elsie Sowah
In: Mini-invasive Surgery · 2020 · doi:10.20517/2574-1225.2019.59 · W3037328258
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⚙ AI-generated summary by claude@2026-06, 2026-06-09 ⓘ

This review examined endometrioma surgery for adolescents and young women, finding that patient age, cyst size, and type influence management timing, with larger or bilateral cysts impacting ovarian reserve more significantly.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-09 ⓘ

This paper reviews evidence on whether ovarian endometrioma surgery should be performed before assisted reproductive therapy, with particular emphasis on adolescents and very young women, using a literature search focused on outcomes such as implantation and pregnancy rates. Across 30,741 patients supporting surgery and 9,983 opposing it, the review reports only one statistically significant study favoring surgery, with lower implantation and pregnancy rates in the surgical-removal group (8.2% vs. 12% implantation; 14.9% vs. 24.9% pregnancy), while repeatedly noting that surgery can worsen ovarian reserve—especially with larger cyst size, pseudocapsule stripping, and older age—whereas larger endometriomas and younger age are linked to higher recurrence. A major limitation is that the evidence base is dominated by retrospective designs, with few prospective studies, and that patient stratification tools for identifying “at-risk” progression are described as lacking. This paper is centrally about endometriosis — specifically the management of ovarian endometriomas with surgery timing for early disease control and fertility preservation in adolescents and very young women.

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Abstract

Aim: The purpose of this study is to investigate the efficacy of surgical management in ovarian endometrioma for early disease control and long-term fertility preservation in adolescents and women of very young age. A history of cyclic pains in adolescents is highly associated with endometriosis. Sonography enables the diagnosis of small endometriomas 1-2 cm in diameter. Although it is obvious that the risk of damage to normal ovarian tissue is diminished when operating and removing a 2 cm endometrioma, it is not approved since there are currently no tools available to identify at-risk patients. Additionally, performing laparoscopic surgery with 5 mm instruments in patients with small endometriomas will likely cause more harm than benefit. Methods: A literature review was performed using key words for endometrioma surgery, in vitro fertilization (IVF), implantation rate, pregnancy rate and adolescents. The pros and cons of surgical removal prior to assisted reproductive therapy (ART), outcomes of endometrioma surgical treatment before IVF, and current recommendations for endometrioma removal were investigated. Results: The total patient population from articles supporting removal of endometrioma before assisted reproductive therapy and evidence against were 30,741 and 9983 respectively. However, the only study reporting a statistically significant result found an 8.2% implantation rate for the surgical removal group vs . 12% in the direct-to-IVF group, and 14.9% pregnancy rate in the surgical removal group vs . 24.9% in the direct-to-IVF group. Damage to ovarian reserve and function due to surgery is exacerbated by large cyst size, stripping of the pseudocapsule and older age. Larger endometrioma, ablation of the endometrioma base and younger age are associated with higher recurrence rate. Conclusion: The patient’s age, in addition to the size and type of endometrioma, can direct and indicate the timing of surgical management. Bilateral endometriomas and those larger than 7 cm are associated with more damage to ovarian reserve due to disease and surgery, as compared with unilateral lesions and those smaller than 7 cm. High-risk adolescents and very young women seeking fertility treatment can thus benefit from an early diagnosis of endometrioma. Treatment by trans vaginal hydro-laparoscopy of selected cases can probably be suggested for the treatment of small endometriomas, since 5fr instruments are used following microsurgery principles. Therefore, an early diagnosis of endometrioma, especially in young patients, must be encouraged, improved and standardized, through stepwise clinical reasoning and diagnostic testing.

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endometriosisendometrioma

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