Fertility outcome following laparoscopic cystectomy in patients with chocolate cyst

Background: Ovarian endometrioma (chocolate cyst) is a common manifestation of endometriosis and a significant cause of infertility in reproductive-age women. Laparoscopic cystectomy is widely employed to improve fertility outcomes, yet the extent of its effectiveness and influencing factors remain subjects of ongoing investigation. Objective: To evaluate 12-month fertility outcomes following laparoscopic excision of chocolate cysts in women presenting with infertility and to identify factors associated with successful conception. Methods & Materials: This prospective observational study was conducted at the Department of Obstetrics and Gynecology, Anowar Khan Modern Medical College, Chattogram, Bangladesh, from January to December 2024. A total of 138 infertile women aged 20–40 years with diagnosed ovarian endometrioma underwent laparoscopic cystectomy. Clinical pregnancy within 12 months post-surgery was the primary outcome, with follow-ups conducted every 3 months. Data were analyzed using SPSS, with p<0.05 considered statistically significant. Results: The overall pregnancy rate within 12 months was 65.2%, including 52.2% spontaneous conception and 13.0% through assisted reproductive techniques. Most conceptions occurred within the first 6 months (48.9%). Significant predictors of successful pregnancy included age <35 years (72.3% vs 49.1%, p=0.02), unilateral cysts (69.8% vs 52.4%, p=0.03), and Stage III endometriosis (70.7% vs 57.1%, p=0.04). Cyst size did not significantly affect pregnancy outcomes. Among pregnancies, 86.7% resulted in live births, while 13.3% ended in miscarriage. Conclusion: Laparoscopic cystectomy offers favorable fertility outcomes in women with ovarian endometrioma, particularly those who are younger, have unilateral cysts, and less advanced disease. Careful patient selection and fertility counseling are crucial to optimize outcomes while preserving ovarian reserve.