Ovarian Tissue Removed with Endometrioma May Reflect the Quality of the Adjacent Ovary

<b>Background/Objectives</b>: Endometriosis is commonly associated with infertility due to multiple factors. In this paper, we investigated the histopathological factors underlying these effects by comparing microscopic samples obtained during laparoscopic stripping. <b>Methods</b>: Morpho-functional examination through the follicular Score (FS) of ovarian tissue adjacent to the cystic wall (Specimen 1) was compared with the FS of ovarian tissue inadvertently harvested during cystectomy (Specimen 2). The follicular score was compared with clinical factors such as age, parity, BMI, and CA-125 levels. <b>Results</b>: Cohen's kappa analysis revealed a 77.8% concordance between the follicular score of the ovarian tissue alongside the endometrioma (S1) and the ovarian tissue inadvertently removed (S2), reflecting a moderate level of concordance between the two samples. A statistically significant positive correlation was observed between the FS of Specimen 1 and the preoperative CA-125 value (<i>p</i> = 0.01); in contrast, a negative correlation was found between the FS and both the patient's age (<i>p</i> = 0.006) and parity (<i>p</i> = 0.03). Additionally, a statistically significant negative correlation was demonstrated between the FS of Specimen 2 and patient age (<i>p</i> = 0.04). <b>Conclusions</b>: The functional quality of the remaining ovary after endometrioma stripping may be assessed by evaluating the follicular score of the pericystic ovarian tissue.