Cystic ovarian endometriosis and infertility: arguments for an early but less aggressive surgical treatment

Endometriosis and especially cystic ovarian endometriosis are considered a major cause of female infertility. Cystic ovarian endometriosis is moreover generally associated with ovarian and tubal adhesions causing mechanical infertility.1 Cystic ovarian endometriosis is also associated with superficial pelvic endometriosis and with deep endometriosis.1,2 It remains debated why endometriosis by itself decreases fertility.3 The hypotheses vary from an effect on ovarian function and ovulation,4–6 toxic factors for spermatozoa and oocytes in peritoneal fluid, an altered tubal transport and implantation problems because of immunologic changes, to endometrial changes in endometriosis7 and a different endometrial microbiome.8