Surgical Management of Ovarian Endometrioma: Impact on Ovarian Reserve Parameters and Reproductive Outcomes

Angelos Danilidis, Georgios Grigoriadis, Dimitrios Rafail Kalaitzopoulos, Stefano Angioni, Üzeyir Kalkan, Adrien Crestani, Benjamin Merlot, Horace Roman
2023 · doi:10.20944/preprints202307.1698.v1 · W4385253210
preprint OA: green CC0 ⤵ 4 in-corpus citations
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⚙ AI-generated summary by claude@2026-06, 2026-06-08 ⓘ

This review summarized literature on surgical management of ovarian endometriomas, finding that cystectomy may improve conception chances but reduce AMH, while ablative methods preserve ovarian reserve better.

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Abstract

Ovarian endometriomas have a negative impact on a patient’s reproductive potential and likely cause a reduction in ovarian reserve. The most commonly employed ovarian reserve parameters are anti-mullerian hormone (AMH) and antral follicular count (AFC). Surgical management options of endometrioma include cystectomy, ablative methods, ethanol sclerotherapy and combined techniques. The optimal surgical approach remains a matter of debate. Our review aimed to summarize the literature on the impact of surgical management of endometrioma on AMH, AFC and fertility outcomes. Cystectomy may reduce recurrence rates and increase chances of spontaneous conception. However, a post-operative reduction in AMH is to be anticipated, albeit there is evidence of recovery during follow-up. The reduction in ovarian reserve is likely multi-factorial. Cystectomy does not appear to significantly reduce, and may even increase, AFC. Ablative methods achieve an ovarian tissue-sparing effect and improved ovarian reserve, compared to cystectomy, has been demonstrated. A single study reported on AMH and AFC post- sclerotherapy and both were significantly reduced. AMH levels may be useful in predicting the chances of conception post-operatively. None of the aforementioned approaches has clearly demonstrated a superiority in terms of overall chances of conception. Surgical management of endometrioma may, overall, improve probability of pregnancy. Evidence on its value before medically-assisted reproduction (MAR) is conflicting, however, a combination of surgery followed by MAR may achieve the optimal fertility outcome. In view of the complexity of available evidence, individualisation of care, combined with optimal surgical technique, is highly recommended.

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endometrioma

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