Endometrioma and Infertility: Principles and Techniques of Management

  • Tülay Karasu
  • Bolarinde OlaEmail author


Endometriosis occurs when endometrial tissue is detected outside of the uterus. The prevalence of endometriosis depends on the diagnostic method, but ranges between 25 and 40 % of women. The relationship of endometriosis to infertility is not always clear-cut. A review of 32 studies by Eskenazi showed that up to 78 % of infertile women had endometriosis. Similarly, D’Hooghe et al. pooled 13 studies, demonstrating that up to 50 % of previously fertile women had proven endometriosis. An endometrioma is formed following the invagination of endometriotic deposits on the ovarian cortex, eventually forming what is commonly described as ‘chocolate’ cysts. Ovarian endometriomas are found in 17–44 % of women with endometriosis. Although the ovaries are the commonest sites of endometriomas, there are numerous reports of extra-gonadal chocolate cysts in distant locations like the umbilicus, brain, liver and other sites. These extra-gonadal lesions do not, however, have direct effects on infertility.


Endometrioma and infertility Infertility and endometrioma Endometriosis Umbilical endometrioma Chocolate cysts Extra-gonadal chocolate cysts Ovarian endometriomas 


  1. 1.
    Buck Louis GM, Hediger ML, Peterson CM, Croughan M, Sundaram R, Stanford J, et al. Incidence of endometriosis by study population and diagnostic method: the ENDO study. Fertil Steril. 2011;96(2):360–5.CrossRefPubMedCentralPubMedGoogle Scholar
  2. 2.
    Eskenazi B, Warner ML. Epidemiology of endometriosis. Obstet Gynecol Clin North Am. 1997;24(2):235–58.CrossRefPubMedGoogle Scholar
  3. 3.
    D'Hooghe TM, Debrock S, Hill JA, Meuleman C. Endometriosis and subfertility: is the relationship resolved? Semin Reprod Med. 2003;21(2):243–54.CrossRefPubMedGoogle Scholar
  4. 4.
    Nisolle M, Donnez J. Peritoneal endometriosis, ovarian endometriosis, and adenomyotic nodules of the rectovaginal septum are three different entities. Fertil Steril. 1997;68(4):585–96.CrossRefPubMedGoogle Scholar
  5. 5.
    Redwine DB. Ovarian endometriosis: a marker for more extensive pelvic and intestinal disease. Fertil Steril. 1999;72(2):310–5.CrossRefPubMedGoogle Scholar
  6. 6.
    Busacca M, Vignali M. Ovarian endometriosis: from pathogenesis to surgical treatment. Curr Opin Obstet Gynecol. 2003;15(4):321–6.PubMedGoogle Scholar
  7. 7.
    Galasso A, Sherman BG, Burn VE. Umbilical endometrioma. JAMA. 1934;102(22):1845–6.CrossRefGoogle Scholar
  8. 8.
    Efremidou EI, Kouklakis G, Mitrakas A, Liratzopoulos N, Polychronidis AC. Primary umbilical endometrioma: a rare case of spontaneous abdominal wall endometriosis. Int J Gen Med. 2012;5:999–1002.CrossRefPubMedCentralPubMedGoogle Scholar
  9. 9.
    Thibodeau LL, Prioleau GR, Manuelidis EE, Merino MJ, Heafner MD. Cerebral endometriosis. case report. J Neurosurg. 1987;66(4):609–10.CrossRefPubMedGoogle Scholar
  10. 10.
    Huang WT, Chen WJ, Chen CL, Cheng YF, Wang JH, Eng HL. Endometrial cyst of the liver: a case report and review of the literature. J Clin Pathol. 2002;55(9):715–7.CrossRefPubMedCentralPubMedGoogle Scholar
  11. 11.
    Rivkine E, Jakubowicz D, Marciano L, Polliand C, Poncelet C, Ziol M, et al. Hepatic endometrioma: a case report and review of the literature: report of a case. Surg Today. 2013;43(10):1188–93.CrossRefPubMedGoogle Scholar
  12. 12.
    Padilla SL. Ovarian abscess following puncture of an endometrioma during ultrasound-guided oocyte retrieval. Hum Reprod. 1993;8(8):1282–3.PubMedGoogle Scholar
  13. 13.
    Yaron Y, Peyser MR, Samuel D, Amit A, Lessing JB. Infected endometriotic cysts secondary to oocyte aspiration for in-vitro fertilization. Hum Reprod. 1994;9(9):1759–60.PubMedGoogle Scholar
  14. 14.
    Nargund G, Parsons J. Infected endometriotic cysts secondary to oocyte aspiration for in-vitro fertilization. Hum Reprod. 1995;10(6):1555.CrossRefPubMedGoogle Scholar
  15. 15.
    Fujishita A, Khan KN, Masuzaki H, Ishimaru T. Influence of pelvic endometriosis and ovarian endometrioma on fertility. Gynecol Obstet Invest. 2002;53 Suppl 1:40–5.CrossRefPubMedGoogle Scholar
  16. 16.
    Dunselman GA, Vermeulen N, Becker C, Calhaz-Jorge C, D'Hooghe T, De Bie B, et al. ESHRE guideline: management of women with endometriosis. Hum Reprod. 2014;15.Google Scholar
  17. 17.
    Hughes E, Brown J, Collins JJ, Farquhar C, Fedorkow DM, Vandekerckhove P. Ovulation suppression for endometriosis. Cochrane Database Syst Rev. 2007;(3):CD000155.Google Scholar
  18. 18.
    Rana N, Thomas S, Rotman C, Dmowski WP. Decrease in the size of ovarian endometriomas during ovarian suppression in stage IV endometriosis. Role of preoperative medical treatment. J Reprod Med. 1996;41(6):384–92.PubMedGoogle Scholar
  19. 19.
    Sallam HN, Garcia-Velasco JA, Dias S, Arici A. Long-term pituitary down-regulation before in vitro fertilization (IVF) for women with endometriosis. Cochrane Database Syst Rev. 2006;(1):CD004635.Google Scholar
  20. 20.
    Nothnick WB. The emerging use of aromatase inhibitors for endometriosis treatment. Reprod Biol Endocrinol. 2011;9:87. doi: 10.1186/1477-7827-9-87.CrossRefPubMedCentralPubMedGoogle Scholar
  21. 21.
    Lossl K, Loft A, Freiesleben NL, Bangsboll S, Andersen CY, Pedersen AT, et al. Combined down-regulation by aromatase inhibitor and GnRH-agonist in IVF patients with endometriomas-A pilot study. Eur J Obstet Gynecol Reprod Biol. 2009;144(1):48–53.CrossRefPubMedGoogle Scholar
  22. 22.
    Fertility: assessment and treatment for people with fertility problems issued: NICE clinical guideline 156. [Internet]. 2013. Available from:
  23. 23.
    Chapron C, Vercellini P, Barakat H, Vieira M, Dubuisson JB. Management of ovarian endometriomas. Hum Reprod Update. 2002;8(6):591–7.CrossRefPubMedGoogle Scholar
  24. 24.
    Pados G, Tsolakidis D, Bontis J. Laparoscopic management of the adnexal mass. Ann N Y Acad Sci. 2006;1092:211–28.CrossRefPubMedGoogle Scholar
  25. 25.
    Tsolakidis D, Pados G, Vavilis D, Athanatos D, Tsalikis T, Giannakou A, et al. The impact on ovarian reserve after laparoscopic ovarian cystectomy versus three-stage management in patients with endometriomas: a prospective randomized study. Fertil Steril. 2010;94(1):71–7.CrossRefPubMedGoogle Scholar
  26. 26.
    Hart RJ, Hickey M, Maouris P, Buckett W. Excisional surgery versus ablative surgery for ovarian endometriomata. Cochrane Database Syst Rev. 2008;(2):CD004992.Google Scholar
  27. 27.
    Benschop L, Farquhar C, van der Poel N, Heineman MJ. Interventions for women with endometrioma prior to assisted reproductive technology. Cochrane Database Syst Rev. 2010;(11):CD008571.Google Scholar
  28. 28.
    Kenney SP, Kekuda R, Prasad PD, Leibach FH, Devoe LD, Ganapathy V. Cannabinoid receptors and their role in the regulation of the serotonin transporter in human placenta. Am J Obstet Gynecol. 1999;181(2):491–7.CrossRefPubMedGoogle Scholar
  29. 29.
    Kennedy S, Bergqvist A, Chapron C, D'Hooghe T, Dunselman G, Greb R, et al. ESHRE guideline for the diagnosis and treatment of endometriosis. Hum Reprod. 2005;20(10):2698–704.CrossRefPubMedGoogle Scholar
  30. 30.
    Takashima A, Takeshita N, Otaka K, Kinoshita T. Effects of bipolar electrocoagulation versus suture after laparoscopic excision of ovarian endometrioma on the ovarian reserve and outcome of in vitro fertilization. J Obstet Gynaecol Res. 2013;39(7):1246–52.CrossRefPubMedGoogle Scholar
  31. 31.
    Ferrero S, Venturini PL, Gillott DJ, Remorgida V, Leone Roberti Maggiore U. Hemostasis by bipolar coagulation versus suture after surgical stripping of bilateral ovarian endometriomas: a randomized controlled trial. J Minim Invasive Gynecol. 2012;19(6):722–30.CrossRefPubMedGoogle Scholar
  32. 32.
    Tsoumpou I, Kyrgiou M, Gelbaya TA, Nardo LG. The effect of surgical treatment for endometrioma on in vitro fertilization outcomes: a systematic review and meta-analysis. Fertil Steril. 2009;92(1):75–87.CrossRefPubMedGoogle Scholar
  33. 33.
    Benaglia L, Bermejo A, Somigliana E, Faulisi S, Ragni G, Fedele L, et al. In vitro fertilization outcome in women with unoperated bilateral endometriomas. Fertil Steril. 2013;99(6):1714–9.CrossRefPubMedGoogle Scholar
  34. 34.
    Rickes D, Nickel I, Kropf S, Kleinstein J. Increased pregnancy rates after ultralong postoperative therapy with gonadotropin-releasing hormone analogs in patients with endometriosis. Fertil Steril. 2002;78(4):757–62.CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag London 2015

Authors and Affiliations

  1. 1.Department of Reproductive Medicine and SurgerySheffield Teaching Hospital NHS Foundation TrustSheffieldUK

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