Endometrioma: Should this be Managed Before In Vitro Fertilization (FIV)?

Endometriosis is a common gynaecological disorder in which endometrial tissue (glandular epithelium and stroma) is found outside the uterine cavity. It affects 20-40% of women who complain of subfertility, although it can be found also in 5-10% of fertile women. Endometriosis mostly presents as superficial and deep pelvic peritoneal implants, adhesions and ovarian cysts. Characteristic symptoms include dyspareunia, severe dysmenorrhoea and chronic pelvic pain. It has been believed for almost a century by the majority of academic opinion that endometriosis is a disease caused by shedding of menstrual endometrium and its dissemination throughout the pelvis. Transvaginal ultrasound is an increasingly accepted technique for the diagnosis of an ovarian endometrioma. The primary indications for treatment of ovarian endometriomas are the symptoms of pelvic pain and dyspareunia (pain during or after sexual intercourse). There is a lack of randomized controlled studies to report definitively the impact of endometriomas and conservative surgery of ovarian prior to IVF/ICSI cycles. The most effective method of laparoscopic surgery remains controversial.