Impact of Surgery for Ovarian Endometriomas on the Outcomes of In Vitro Fertilization

Endometrioma is a cystic lesion of ovaries originating from endometrial glands and stroma. Endometrioma is one of the more frequent representations of endometriosis, it is identified in 17–44% of patients with endometriosis. In the last few years, several studies have reported the possible link between endometrioma and infertility. Available evidence has suggested that endometrioma could damage ovarian function; the fluid in the cyst represents a potential source of ‘toxicity’ for the surrounding healthy tissue with consequently altered function of ovarian physiology. In consideration of the increased focus on the pathophysiological mechanisms of endometrioma, surgical excision has commonly been considered to avoid further ovarian damage. Women who received laparoscopic cystectomy for endometrioma presented diminished serum AMH concentrations. After surgical treatment, the AMH levels progressively decreased in 6–9 months, and it is related to the endometrioma size. Patients with endometrioma frequently require assisted reproductive technology (ART), the surgical excision of endometrioma may not improve assisted fertility results and may further decrease the number of oocytes retrieved in the affected females. Also, in patients with unassisted conception, the surgical excision of endometrioma causes reduced ovarian reserve in a short time, which may delay achieving pregnancy. In cases of bilateral endometrioma, there is a higher risk of premature ovarian insufficiency following cystectomy. Women with endometriosis have experimented with lower implantation and pregnancy rate; the oocytes from patients with endometriosis have a differential gene expression pattern, with deregulation involved in abnormal oocyte and embryo development. Ovarian endometriosis could be responsible for the reduction of oocyte quality in these patients. Fertility preservation offers a valid treatment option to clinicians and their patients with endometriosis to help them increase their reproductive chances in the future. The detrimental effect of surgical excision of ovarian endometriomas in young women could be indicated by surgery after ovarian stimulation for fertility preservation. The surgery for endometrioma should be considered after ART when it is possible.