Ovarian Endometrioma Surgery - How to Safeguard the Follicular Reserve

Ovarian endometrioma is a particular anatomopathological entity in the context of endometriotic pathology. The ovary is theorgan most frequently affected by endometriosis and in 30% of cases, the pathology is bilateral. The effect of endometriosis onfertility is varied; however, women with severe endometriosis and the presence of endometriomas appear to have significantlylower pregnancy rates, also following IVF treatment, when compared with women with severe endometriosis but withoutendometriomas. Surgical treatment is indicated if the endometrioma becomes symptomatic and increases in size despitemedical therapy, and in cases of related infertility. However, endometrioma surgery can reduce the follicular reserve eitherthrough stripping that does not take into account the correct cleavage plan and involves an exaggerated “traction-countertraction”, or with an indiscriminate electro-hemostasis or, with a too narrow suture that causes ischemia. In considerationof this important issues, we have organized a surgical-excision technique that tries to safeguard as much as possible thefollicular reserve of the ovary affected by endometriosis.