- Not every endometrioma needs surgery.
- Technique choice affects ovarian reserve.
- IVF vs surgery order is individualised.
When to operate
Cysts under 4 cm without pain or fertility concern can often be monitored. Cysts over 4 cm, painful cysts, or cysts in a woman planning IVF frequently need surgical treatment first.
Cystectomy vs ablation
Laparoscopic cystectomy (removing the cyst wall) has lower recurrence than ablation but reduces ovarian reserve slightly. In women with low AMH or bilateral endometriomas, ablation with plasma energy is a fertility-preserving alternative.
Frequently asked questions
Does surgery affect AMH?
Yes, moderately. This is why technique choice matters.
Can endometriomas recur?
Yes — recurrence is around 20% at 5 years without hormonal suppression.
Should I do IVF or surgery first?
It depends on cyst size, symptoms and AMH. This decision needs a consultant conversation.
Could a doctor-led plan help you?
A 30-minute video consultation with Dr Berra Önsoy — reviewing your symptoms and imaging and giving you a clear personalised plan for endometriosis surgery.
Request a video consultation