Infertility Associated with Ovarian Endometriomas: Surgery or In-Vitro Fertilization?

Ovarian endometriomas are frequently associated with female infertility. The choice of treatment in these cases is one of the most discussed topics in Reproductive Medicine, and the approach to the patient should be tailored based on different parameters. Management options include surgery, In-Vitro Fertilization (IVF), or a combination of both. Laparoscopic excision of the ovarian endometrioma should be the treatment of choice when there is associated pain. Surgery should be performed following appropriate techniques to reduce the possible damage to the ovarian reserve. Pregnancy rates around 50% have been consistently reported after surgery, which compare favorably with those obtained with IVF. IVF may be preferred in case of associated male or tubal factor, in case of a reduced ovarian reserve, or if previous surgery has failed, particularly if there is no associated pain, and when the ultrasonographic features of the ovarian cyst are reassuring. Sometimes IVF may be preceded by surgery, when a difficult access to follicles at pick-up, due to the size and location of the ovarian cyst, or to severe adhesions, is anticipated.