A 32-year-old woman with endometriosis and infertility undergoes laparoscopy. A 5 cm right ovarian endometrioma is found. She has been trying to conceive for 18 months. Which intervention best improves natural conception rates in this scenario?
- A GnRH agonist for 6 months prior to attempting IVF
- B Aspiration of the endometrioma contents only
- C Immediate IVF without surgical intervention
- D Laparoscopic cystectomy (stripping technique) of the endometrioma ✓
Explanation
Multiple RCTs and meta-analyses (Beretta 1998, Alborzi 2004) demonstrate that laparoscopic excision (cystectomy/stripping) of ovarian endometriomas ≥4 cm improves spontaneous pregnancy rates compared to aspiration alone (which has high recurrence). Cochrane review 2008 confirmed superior spontaneous pregnancy rates after cystectomy versus drainage/ablation. GnRH agonist alone does not treat the structural problem. Immediate IVF is reasonable for severe cases but cystectomy first is recommended for large endometriomas as it removes the inflammatory milieu harmful to oocytes and improves ovarian response.
Reference: Shaw's Textbook of Gynaecology, 17th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.