A 35-year-old woman with deeply infiltrating endometriosis and a 3 cm chocolate cyst (endometrioma) presents with 18 months of primary infertility. Which management approach has the strongest evidence for improving natural conception rates?

• A Long-term gonadotrophin-releasing hormone agonist (GnRH-a) for 6 months before attempting conception
• B Laparoscopic cystectomy (stripping technique) of the endometrioma prior to IVF, as it improves oocyte yield
• C Combined oral contraceptive pill suppression for 6 months followed by spontaneous conception attempts
• D Laparoscopic cystectomy for endometrioma and excision of deep endometriosis improves spontaneous pregnancy rates compared to diagnostic laparoscopy alone ✓

Explanation

The Canadian Collaborative Group and ENDOCAN-1 data support that surgical resection of visible endometriosis including endometrioma cystectomy (stripping technique) improves spontaneous pregnancy rates in minimal-mild disease. GnRH agonists suppress disease temporarily but do not improve cumulative pregnancy rates without surgery. For IVF, draining/ablating (not stripping) the endometrioma may avoid ovarian reserve damage; stripping before IVF can reduce ovarian response. COCP does not improve fecundity.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.