The impact of laparoscopic ovarian cystectomy for infertile woman with endometriomas prior to IVF/ICSI cycles

Endometriosis is a common, benign, chronic gynecological disorder frequently associated with dysmenorrhea, pelvic pain, and infertility. The prevalence of endometriosis approaches 10-15% of all women of reproductive age while it has been reported that 25-40%of women within fertility have endometriosis. Current guidelines for the treatment of endometriosis include medical or surgical therapies. However, medical treatment has a limited role in the treatment of endometriosis that only offers symptomatic control. Associated with many advantages over traditional abdominal methods, including less hospitalization, smaller incisions, faster recovery time, and faster return to work, the laparoscopic approach for endometriosis has been now widely accepted. Therefore, laparoscopic surgery has traditionally been the standard treatment for patients with endometriosis. Until now, there is no consensus regarding the influence of previous surgery for endometriomas on ovarian function. Some investigators suggested that in vitro fertilization (IVF) outcome is compromised by previous ovarian surgery. Conversely, no adverse impact of prior surgery for endometriosis on ovarian reserve and response to controlled ovarian hyperstimulation (COH) has also been reported. The role of operative laparoscopy before or after IVF in women accompanied with ovarian endometrioma is more complicated. The recent guideline for management of endometriosis in women requiring IVF recommend surgery only carried out in the presence of large ovarian endometrioma. Hence, it needs thorough evaluation in managing ovarian endometriomas for infertile women.