Endometriosis Surgery and Fertility Outcomes: An Evidence-Based Review

Indunil Piyadigama, Gaya Jeewan Bandara, Sivapatham Piriyatharsan, Tharika Nadeemali Senevirathne
In: Fertility Science and Research · 2025 · vol. 12 , pp. 24 · doi:10.25259/fsr_17_2025 · W4412849130
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⚙ AI-generated summary by claude@2026-06, 2026-06-08 ⓘ

This review examines how laparoscopic excision, ovarian endometrioma management, and deep infiltrating endometriosis surgery impact fertility outcomes and ART success.

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

This mini-review evaluated evidence on how different endometriosis surgeries affect fertility outcomes, including laparoscopic adhesiolysis, excision versus ablation for early-stage disease, ovarian endometrioma surgery types (cystectomy, drainage, and plasma/electro-thermal ablation), and deep infiltrating endometriosis (DIE) excision, as well as timing and hormonal suppression around assisted reproductive technologies (ART). It reports that operative laparoscopy for minimal/mild endometriosis can improve viable intrauterine pregnancy compared with diagnostic laparoscopy alone (Cochrane: OR 1.89), that cystectomy/argon plasma ablation yield higher pregnancy rates than simple drainage (about 30%), and that endometrioma surgery can reduce ovarian reserve (noted via ~30% AMH declines, especially for large/bilateral cysts). The review highlights that the impact of surgery on fertility for DIE and the incremental benefit of performing surgery before IVF remain debated, with guideline-based caveats (e.g., ovarian endometrioma surgery is primarily for pain/access rather than routinely for fertility), and that mechanisms and comparative outcomes are uncertain across studies. This paper is centrally about endometriosis — specifically, it reviews evidence linking surgical techniques for endometriosis (including endometrioma and DIE surgery) to fertility and ART outcomes.

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Abstract

Endometriosis is a chronic gynaecological disorder characterised by the presence of ectopic endometrial tissue outside the uterus, leading to pain, inflammation, and infertility. Surgical intervention plays a critical role in the management of endometriosis-related infertility by restoring normal pelvic anatomy, improving ovarian function, and enhancing the success of assisted reproductive technologies assisted reproductive techniques (ART). This mini-review examines the impact of various surgical techniques, including laparoscopic excision, ovarian endometrioma management, and deep infiltrating endometriosis surgery, on fertility outcomes. The latest evidence on the role of surgery in improving natural conception rates and in-vitro fertilisation success is explored, along with future directions in minimally invasive techniques.

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Condition tags

endometriosisdie_deep_infiltratingendometriomainfertility

Citation neighborhood

Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. [ expand to 2 hops ] — adds papers reached through this work's immediate citers/citees. Heavier; up to 60 extra dots.

References (28)

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last seen: 2026-06-10T17:14:06.276822+00:00
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