Management of endometrioma before IVF

There are significant concerns regarding the potential deleterious impact of surgical treatment of endometrioma on ovarian reserve and IVF outcome. This is probably related to the technical difficulties encountered in removing the endometrioma adherent to the normal ovarian tissue. Nevertheless, it has been shown that ovaries with endometriotic cysts already exhibited reduced number of follicles and vascular activity compared to other types of benign ovarian cysts.
Any decision for not operating should however be balanced against the risks of conservative management, which include spontaneous rupture or leakage of the endometrioma causing peritoneal irritation, difficult access to some ovarian follicles at the time of oocytes collection and the inadvertent drainage of the endometrioma at the time of oocytes retrieval that may contaminate the needle and adversely affect oocytes and embryos potentials, thus reducing the chance of implantation.
Because of the insufficient evidence to suggest the superiority of surgical treatment versus medical or expectant treatment, the management of women with endometrioma planning to undergo IVF should be individualised.