This paper studied how endometriosis and surgery can affect outcomes in women undergoing in-vitro fertilization (IVF). Based on current evidence, individualized care should be given to patients. 

Endometriosis is a condition where the inner tissue of the uterus (endometrium), grows in other places. Endometrial tissue may grow into a cyst in the ovary, forming an endometrioma. Endometriosis causes pain during menstruation, and reduces fertility in women. Thus, some women undergo in-vitro fertilization (IVF). IVF is a procedure whereby the egg is retrieved from woman, fertilized with the sperm outside the body, and implanted back into the uterus.

Studies have shown that the presence of endometriosis does not adversely affect the birth rate outcomes with IVF. Surgery to treat endometriosis before IVF is widely performed. However, there is limited research on whether this will affect the outcome of IVF. There are risks of surgery such as bleeding, infection, pain, and damage to the ovaries. On the other hand, there are risks of endometriosis such as pregnancy-related complications, infection, and difficult egg retrieval. 

The authors looked at a total of 33 studies, and analyzed the results from these studies.

When compared to women with no endometriosis, women with endometrioma had a similar birth rate. Women with intact endometrioma were 2.83 times more like to have IVF cancellation than women with no endometriosis. Women with endometrioma had a lower average number of eggs retrieved from the ovary. None of the studies reported complications such as bleeding, infection or pain.

Among women with endometrioma, those who had surgery had a similar birth rate, and pregnancy rate as those with untreated endometrioma. The cancellation rate was also similar between women who had surgery and women who did not have surgery. None of the studies reported complications such as pain, infection and bleeding. Women who had surgery for endometrioma needed a higher dose of hormone stimulation of the ovaries. 

The authors concluded that among women with endometrioma, surgery did not alter the outcome of IVF. However, there is a risk of reduced ovarian function. 

Talk to your doctor about what is the best treatment option for you.