Recurrent endometrioma and ovarian reserve: biological connection or surgical paradox?

OBJECTIVE: Cumulative evidence supports the view that ovarian endometriomas originate from ovulatory events and that the ovarian reserve is reduced following surgery. On these bases, we have hypothesized that the risk of recurrence may be related to the residual ovarian reserve of the operated ovary. STUDY DESIGN: We retrospectively selected 45 women scheduled for in vitro fertilization who previously underwent surgical excision of monolateral endometriomas and compared ovarian responsiveness in those who did (n = 24) and did not (n = 21) have a recurrent endometrioma. RESULTS: In the intact ovaries, the mean +/- SD number of codominant follicles in women with and without recurrences was 3.5 +/- 1.7 and 3.7 +/- 2.2, respectively (P = NS). In the affected ovaries, the mean +/- SD number of follicles in gonads with and without recurrences was 2.5 +/- 2.3 and 1.1 +/- 1.5, respectively (P < .05). CONCLUSION: Ovarian responsiveness is higher in gonads that developed recurrent endometriomas.