Ovarian Endometrioma Surgery How to Safeguard the Follicular Reserve

Abstract

M Bardi, G Pezzetti, R Laquintana, G Gangarossa, A Iliakis, C Di Cesare, D Perrucci, B Salerno and P Rosaschino

Ovarian endometrioma is a particular anatomopathological entity in the context of endometriotic pathology. The ovary is the organ most frequently affected by endometriosis and in 30% of cases, the pathology is bilateral. The effect of endometriosis on fertility is varied; however, women with severe endometriosis and the presence of endometriomas appear to have significantly lower pregnancy rates, also following IVF treatment, when compared with women with severe endometriosis but without endometriomas. Surgical treatment is indicated if the endometrioma becomes symptomatic and increases in size despite medical therapy, and in cases of related infertility. However, endometrioma surgery can reduce the follicular reserve either through stripping that does not take into account the correct cleavage plan and involves an exaggerated “traction-counter traction”, or with an indiscriminate electro-hemostasis or, with a too narrow suture that causes ischemia. In consideration of this important issues, we have organized a surgical-excision technique that tries to safeguard as much as possible the follicular reserve of the ovary affected by endometriosis.

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