A 32-year-old woman with a 5 cm endometrioma of the left ovary is planning IVF. Regarding pre-IVF surgical cystectomy, which statement best reflects current evidence?
- A Laparoscopic cystectomy always improves IVF outcomes and should be routinely performed
- B Cystectomy significantly reduces ovarian reserve and should be avoided before IVF unless the cyst causes symptoms or access problems ✓
- C Aspiration of the cyst contents is preferred to cystectomy before IVF to preserve ovarian reserve
- D Endometriomata do not affect IVF outcomes and can be ignored
Correct answer: B. Cystectomy significantly reduces ovarian reserve and should be avoided before IVF unless the cyst causes symptoms or access problems
Explanation
Current evidence (ESHRE 2022 endometriosis guidelines) shows that laparoscopic cystectomy reduces ovarian reserve (AMH and AFC) due to inadvertent removal of cortical tissue. Routine surgery before IVF for endometriomata does not consistently improve live birth rates. Surgery is reserved for cysts causing significant symptoms, access problems at oocyte retrieval, or suspected malignancy. Simple aspiration has high recurrence rates and is not preferred.
Reference: Shaw's Textbook of Gynaecology, 17th ed.
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