A 35-year-old nulliparous woman with severe endometriosis (rASRM Stage IV) desires fertility. Diagnostic laparoscopy confirms bilateral endometriomas and deep infiltrating endometriosis of the uterosacral ligaments. The most fertility-enhancing surgical approach is:

• A Drainage of endometriomas alone to preserve ovarian cortex
• B Cystectomy of endometriomas with excision of deep infiltrating disease ✓
• C Medical suppression with GnRH agonist followed by IVF without surgery
• D Hysterectomy with bilateral oophorectomy

Explanation

For Stage IV endometriosis with endometriomas and deep infiltrating disease in a woman desiring fertility, complete surgical excision — including cystectomy (not drainage) of endometriomas and excision of deep lesions — improves spontaneous conception rates. Drainage alone has high recurrence. GnRH agonist without surgery does not improve live birth rates in Stage IV disease. The decision between surgery and direct IVF depends on ovarian reserve and partner fertility.

Reference: Shaw's Textbook of Gynaecology, 17th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.