Ovarian endometrioma is the most common form of endometriosis. Laparoscopy is frequently chosen for its treatment because medical treatment alone is inadequate. However, the role of laparoscopic treatment of ovarian endometriomas has been challenged by evidence questioning the benefits of surgery, especially in cases of young or infertile women. Other therapeutic modalities include expectant management, medical therapy, and, in cases of infertility, ovulation induction and assisted reproductive technology. None of these treatments offer cure of endometriosis.
The objective of this study was to present data concerning the current management of endometrioma. Benefits and complications after treatment and the impact on in vitro fertilization outcome are also highlighted.
An extensive literature search (PubMed) and Cochrane Library review up to December 2013 were performed using the following keywords: “endometrioma,” “cystectomy,” “infertility,” “IVF,” “malignant transformation,” “management,” and “recurrence.”
There is a lack of data from randomized trials to inform the optimal management of endometriomas with respect to pain relief, recurrence, and fertility.
Conclusions and Relevance
Further studies are needed to determine the optimal management of endometrioma. Currently, there is no evidence that surgical management improves the fertility of women with endometrioma.
Obstetricians and gynecologists, family physicians
After completing this CME activity, physicians should be better able to discuss the increased risk of ovarian cancer in women with endometrioma; advise patients as to why excisional technique is superior to the ablation technique for removing endometrioma with regard to the recurrence of the cyst, pain symptoms, and the chance of a spontaneous pregnancy after the operation; review the common problem of reduction of ovarian reserve after the operation of endometriomas; explain that medical treatment of endometrioma can reduce symptoms but is not curative; explain why reoperation is required in more than half of patients with endometriosis; understand that women with endometrioma do not necessarily need in vitro fertilization to achieve a pregnancy; advise patients that surgery (cystectomy) prior to in vitro fertilization does not improve the fertility of women with endometrioma