Impact of Endometrioma Surgery on Ovarian Reserve

Currently, ovarian endometrioma (OMA) laparoscopic excision using the stripping technique is considered the gold standard among OMA surgical treatments. Excisional surgery allows for pain resolution, a high rate of spontaneous pregnancies and a lower recurrence rate of ovarian cysts when compared to drainage and ablation techniques. Because the follicles are tightly attached to the endometrioma’s pseudo capsule, risking being removed during the cystectomy or damaged by coagulation, a cystectomy may cause healthy loss of ovarian tissue, thus reducing the ovarian reserve and fertility. For this reason, new methods have been developed to be effective and feasible, but also safe, with less impact on the ovarian reserve. In this chapter, we focus on the latest procedures, which may use different energy sources, such as CO2 laser, argon plasma or diode laser. Various studies have demonstrated the pros and cons of each method, including in terms of conservation of the ovarian reserve, by analysing two main markers: the anti-Mullerian hormone (AMH) and the antral follicular count (AFC).