Impact of endometriomas and their removal on ovarian reserve

Purpose of review The effect of endometrioma on ovulatory function and ovarian reserve was unclear. Conflicting opinions exist regarding effect of endometrioma excision on ovarian reserve. Recent findings Endometriomas do not seem to affect ovulatory function. Women with endometrioma have lower antral follicle count and serum anti-Mullerian hormone levels than age-matched healthy controls. There is high-quality evidence suggesting a significant decline in serum anti-Mullerian hormone levels following endometrioma excision. However, a similarly significant decline in antral follicle count is not demonstrated. Cauterization seems to be a contributing factor to ovarian damage and suturing the cyst bed could perhaps be a better alternative. Summary It seems prudent to warn patients regarding loss of ovarian reserve following endometrioma excision. Surgeons should cautiously limit the use of cauterization following stripping of endometrioma. Well designed studies comparing effect of various haemostatic measures on ovarian reserve are needed.