Surgical techniques for ovarian endometriosis

Key content: All patients with ovarian endometriosis should be offered an individualised, shared decision‐making approach informed by clinical history, symptoms and fertility status. Surgical management of ovarian endometriosis can be effective in treating endometriosis‐associated pelvic pain and infertility, but there is no current evidence that surgery for ovarian endometriosis increases the success of in vitro fertilisation (IVF) treatment. Ovarian reserve tests should be considered before any ovarian surgery and can help guide the patient towards the optimal treatment. The Endometriosis Fertility Index should be incorporated into pre‐operative consultations as a validated tool that estimates the likelihood of spontaneous conception following surgical intervention. Surgeons should be trained in different surgical techniques, types of diathermy and haemostatic agents that can minimise the risk of inadvertent injury to normal ovarian cortex. Learning objectives: To facilitate informed decision‐making regarding the treatment of ovarian endometriosis. To gain insight into the possible surgical techniques available to manage ovarian endometriosis and the evidence behind them. To understand the impact of each technique on endometriosis‐associated pain, fertility outcomes and recurrence rates. Ethical considerations: Should fertility preservation be offered to all women of reproductive age with fertility aspirations and a diagnosis of endometriomas? Should integrated care boards (ICBs) devise specific criteria to offer funding for fertility preservation as an option before surgery for ovarian endometriosis?