Endometrioma and Infertility: Principles and Techniques of Management

Abstract

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 [ 1 ]. 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 [ 2 ]. Similarly, D'Hooghe et al. pooled 13 studies, demonstrating that up to 50 % of previously fertile women had proven endometriosis [ 3 ]. An endometrioma is formed following the invagination of endometriotic deposits on the ovarian cortex, eventually forming what is commonly described as 'chocolate' cysts [ 4 ]. Ovarian endometriomas are found in 17-44 % of women with endometriosis [ 5 , 6 ]. Although the ovaries are the commonest site of endometriomas, there are numerous reports of extra-gonadal chocolate cysts in distant locations like the umbilicus [ 7 , 8 ], brain [ 9 ], liver and other sites [ 10 , 11 ]. These extra-gonadal lesions do not, however, have direct effects on infertility.