Surgical treatment of endometriosis prior to IVF/ICSI must be individualized on a case-by-case basis. Surgical removal of an endometrioma, an ovarian cyst produced by endometrial tissue, causes a decrease in the response of the operated ovary. This results in obtaining a lower number of oocytes and embryos, often with the need for a higher dose of gonadotrophin hormones and a longer duration of stimulation.
Therefore, the recommendations of the European Society of Human Reproduction and Embryology (ESHRE) and the Royal College of Obstetricians and Gynaecologists (RCOG) are that surgery should be considered if endometriomas larger than 4 cm are present, in endometriomas that make ovarian puncture difficult, when there is a risk of rupture during ovarian puncture, or risk of recurrence of ovarian abscess, a serious complication of infection.
