Endometrioma and ovarian reserve: effects of endometriomata per se and its surgical treatment on the ovarian reserve

Endometrioma is the cystic lesion of ovaries originating from endometrial glands and stroma. This condition is present in 17 to 44% of endometriosis patients. The ovarian reserve is decreased in women with endometriomas, as compared to similarly aged healthy women or women with other benign ovarian cysts. Some data suggest women with endometrioma experience a faster decline in AMH than age matched healthy women. Multiple well-designed studies consistently demonstrate that surgical excision of endometrioma is associated with a decline in the ovarian reserve. Recent studies with long term follow up suggest some recovery in the markers of ovarian reserve, but they almost never reach preoperative levels. The energy modality and choice of hemostatic method may be important. Limited data suggest ablation of the cyst wall with plasma energy is associated with less harm to reserve with similar recurrence rates as compared with excision and bipolar coagulation. In conclusion, bipolar diathermy seems to be the most harmful hemostatic method to ovarian reserve and its use should be cautiously minimized.