Surgical Treatment of Endometriomas: Impact on Ovarian Reserve

Women with ovarian endometriosis are at risk for injury to the ovarian reserve due to the pathophysiology of the endometrioma and iatrogenic injury associated with surgical intervention. Serum AMH levels decrease by up to 44% following endometrioma excision. Several strategies can help attenuate ovarian injury during excision, including meticulous surgical technique, and the use of suture and hemostatic sealants as alternatives to electrosurgery. This chapter will provide a description of surgical approaches for the treatment of endometriomas, their impact on the ovarian reserve, and strategies to minimize ovarian injury.