Ovarian Endometriosis

Ovaries are frequent sites for endometriosis, and endometriomas constitute an important subtype of this condition due to their easy detectability and their impact on fertility and fertility treatment. While all treatment options for endometriosis are applicable to ovarian endometriosis, surgical treatment is required for a significant proportion of women with endometriomas. Surgical treatment options include laparoscopic or ultrasound-guided drainage, excision and ablation/coagulation. Sclerotherapy which involves intracystic administration of ethanol, methotrexate and tetracycline has also been described. Excisional surgery is considered to be the gold standard as it results in better spontaneous pregnancy rates, and lower recurrence of pain and endometrioma. Surgery is known to reduce ovarian reserve, and this can make management of endometriomas more challenging in older women with low ovarian reserve and in those with a history of previous endometrioma surgery. Surgery for endometrioma prior to assisted reproduction treatment does not improve pregnancy rates but can make ovarian stimulation more difficult.