Dr Randy Morris MD-The BOARD CERTIFIED fertility expert with weekly TTC tips on InfertilityTV

Endometriosis is a common problem which can cause both infertility and pain. Doctors grade endometriosis based on how much is present in your body. The grading goes from stage 1 or minimal to stage 4 or severe. If you have stage 3 or 4 then you have these cysts in your ovaries called endometriomas.

If your doctor sees these cysts, should you have surgery to remove them? The answer is complex. On the one hand, some studies do show an improvement in your chance to get pregnant by having surgery. On the other hand, ANY surgery on the ovaries will cause the loss of some of your valuable reserve of remaining eggs. Women with decreased ovarian reserve have a lower chance for getting pregnant.

Endometrioma cysts can be difficult to remove and it’s common to have some bleeding in the ovary which the doctor has to stop. To do that, he or she will often use electricity to cauterize the bleeding. Its very effective, BUT is more likely to cause the loss of eggs.

So this question is probably best answered by having a consultation with your physician after close review of all of the variables in your case. Here are some general guidelines. Consider leaving those endometriomas alone if

You are older
You already have borderline or low ovarian reserve
You have previously responded poorly to fertility medications
You have large endometriomas or have them on both ovaries
You have already had ovarian surgery in the past

If you and your doctor have decided that surgery is best for you then make an agreement that less traumatic methods to stop bleeding like suturing or gels be tried before resorting to electro cautery

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