Impact of surgical treatment of ovarian endometrioma on fertility

Introduction. Ovarian endometrioma is a common ma­ni­fes­ta­tion of endometriosis, and it is associated with infertility. Two main surgical treatments have been de­scribed: complete laparoscopic excision and conservative tech­niques. These methods are substantially different re­gar­ding their efficacy and the risk of afflicting the ovarian re­serve, therefore their impact on fertility requires a critical as­ses­sment. Objective. The aim of the study was to com­pare the effects of major surgical methods on fertility in wo­men diagnosed with ovarian endometrioma. Materials and method. A systematic literature review, from 2019 to 2024, was performed, using PubMed, MEDLINE, Scopus, Coch­rane, and Google Scholar databases, using keywords such as “ovarian endometrioma”, “surgical treatment”, “fertility” and “ovarian reserve”. Thirty-eight original studies, twelve meta-analyses and seven review articles were in­clu­ded. The parameters evaluated were the recurrence rate, the anti-Müllerian hormone level and the spontaneous preg­nancy rate. Chi-square test and Cox proportional ha­zard analysis were the statistical tests applied. Results. The com­plete laparoscopic excision significantly reduced the re­cur­rence rates compared to drainage or cyst wall ablation (12% versus 33%; p<0.01). However, this procedure caused a more pronounced decrease of ovarian reserve, measured by anti-Müllerian hormone (AMH), with a mean reduction of 35% compared to 12% after conservative methods (p<0.05). The spontaneous pregnancy rate after excision was approximately 50%, higher than the 27% rate observed with conservative techniques (p<0.05). Conclusions. The com­plete laparoscopic excision of ovarian endometrioma pro­vi­ded a superior disease control and higher spontaneous preg­nancy rates compared to conservative methods. How­ever, the fertility benefit must be balanced against the risk of re­duced ovarian reserve. The choice of the surgical method should be individualized, considering age, cyst size and the re­pro­duc­tive desire.