Management of Ovarian Endometrioma in Asymptomatic Reproductive Age Women

Purpose of Review In asymptomatic women of reproductive age, the presence of an ovarian endometrioma raises a significant management dilemma. Recent Findings Surgical management may afford more definitive treatment as well as an opportunity to treat concurrent extra-ovarian endometriotic disease. However, the associated impact on ovarian reserve with ovarian surgery may be an example of the cure being worse than the disease. Several conservative treatments have been studied, all with varying clinical benefits. Expectant management, while a conservative option, may complicate access to growing ovarian follicles and raise risk of surgical site infection during assisted reproductive treatment. Furthermore, a growing body of data suggests that prolonged exposure to the inflammatory endometrioma contributes to ovarian follicular burnout and cortical scarring. Summary For patients with a diagnosis of endometrioma who are actively trying to conceive, careful patient counseling and shared decision making represent the best way to decide on a management strategy in order to maximize patient-centered outcomes and reproductive potential.