Surgical removal of endometriotic ovarian cysts (endometriomas) is not always necessary. Any surgical procedure on the ovaries carries a risk of reducing ovarian reserve, meaning it could impact fertility by decreasing the number of remaining eggs. The decision to operate depends on a careful evaluation of risks and benefits.  

In general, cysts smaller than 6 cm do not require surgery unless they are causing significant symptoms. For larger cysts, the option of surgery should be carefully considered based on the individual case.  

A newer, less invasive technique called cyst alcoholization has been developed as an alternative to traditional surgery. This involves draining the cyst via a vaginal or laparoscopic approach and injecting absolute alcohol into the cavity for about ten minutes. The alcohol helps harden and collapse the cyst walls, reducing the risk of recurrence without significantly affecting ovarian function. This technique preserves ovarian reserve better than conventional cyst removal surgery.  This technique is not routinely proposed.

Should All Women with Endometriosis-Related Infertility Undergo Surgery?  

Surgery is not always necessary for women with endometriosis who are struggling with infertility. If pain is not a major issue, assisted reproductive technologies (ART), such as in vitro fertilization (IVF), are often the first-line approach. IVF is generally more effective than intrauterine insemination (IUI), especially in cases of moderate to severe endometriosis.  

Surgery may be considered in specific cases where removing endometriosis lesions could improve the chances of conception, whether naturally or through fertility treatments. However, the decision should be made on an individual basis, weighing the potential benefits for fertility against the risks of surgery. Consulting a fertility specialist is key to determining the best approach.  

Learn. Improve. Maintain.  

Managing endometriosis-related infertility requires a personalized strategy. Learning about treatment options, improving ovarian health through tailored medical approaches, and maintaining close follow-ups with fertility and endometriosis specialists can help navigate the journey toward conception.