Is there a benefit for surgery in endometrioma-associated infertility?

PURPOSE OF REVIEW: To summarize the literature related to the value of surgery in endometrioma-associated infertility and present the most recent evidence in support or against the surgical removal of endometriomas with special attention before commencing in-vitro fertilization (IVF) treatment. RECENT FINDINGS: Many studies support the evidence that surgical removal of endometriomas is deleterious to ovarian reserve and function. There is now convincing evidence that surgery for removal of endometriomas does not offer any additional benefits in terms of fertility outcomes. Other concerns after surgery are a higher risk of premature ovarian failure, earlier age at menopause, and higher cancellation rates in IVF cycles as well as the inherent risks of an invasive procedure. SUMMARY: Laparoscopic surgery for the removal of endometriomas is still a very common practice in the field of reproductive medicine. Although endometriomas per se may be detrimental to the ovarian reserve, the current evidence points toward an even lower ovarian reserve after surgery. Additionally, a reduced response of the ovaries to gonadotrophins has been described in different studies after surgical removal of endometriomas. The quality of the oocytes retrieved in IVF cycles is not improved after surgery. Patients going through an operative procedure might extend the time to pregnancy. Surgery should be envisaged only in specific circumstances such as pelvic pain or difficult access to growing follicles but not offered to every single patient with endometrioma-associated infertility.