Cystic ovarian endometriosis and infertility: arguments for an early but less aggressive surgical treatment

Cystic ovarian endometriosis is a cause pain and of infertility. For infertility, surgical treatment has been suggested for cysts larger than 3 or 4cm in diameter only. Surgical treatment is moreover postponed as long as possible or until pain becomes too severe in order to avoid ovarian damage and a decreased ovarian reserve and to avoid recurrences and repeat surgery and adhesion formation. Our recent understanding of the pathophysiology of endometriosis, of its initiation and its growth, probably permits a more effective prevention of recurrences. In addition, adhesion free surgery has become a reality. We therefore suggest performing surgery for cystic ovarian endometriosis early in life when cysts are small followed by an active prevention of recurrences. When cysts are small superficial destruction instead of excision seems logical. Also, THL and under-water coagulation should be considered In conclusion, without discussing the management of larger symptomatic cystic endometriosis, we suggest that early surgical treatment of small cyst is the way to go.