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Randomized evidence has shown that laparoscopic treatment of minimal or mild endometriosis can improve fecundity compared with diagnostic laparoscopy alone. In a large Canadian randomized trial, women who underwent resection or ablation of visible endometriosis had a higher probability of ongoing pregnancy over follow-up. Separate randomized studies also demonstrate improvements in pain after excisional surgery. For clinicians, treatment decisions should integrate symptoms, age, ovarian reserve, infertility duration, disease extent and other fertility factors. Surgery is not automatically beneficial for every endometriosis patient, particularly when ovarian reserve may be compromised by repeated ovarian surgery. The evidence supports a selective, fertility-aware approach rather than routine surgery for all disease.
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Randomized evidence has shown that laparoscopic treatment of minimal or mild endometriosis can improve fecundity compared with diagnostic laparoscopy alone. In a large Canadian randomized trial, women who underwent resection or ablation of visible endometriosis had a higher probability of ongoing pregnancy over follow-up. Separate randomized studies also demonstrate improvements in pain after excisional surgery. For clinicians, treatment decisions should integrate symptoms, age, ovarian reserve, infertility duration, disease extent and other fertility factors. Surgery is not automatically beneficial for every endometriosis patient, particularly when ovarian reserve may be compromised by repeated ovarian surgery. The evidence supports a selective, fertility-aware approach rather than routine surgery for all disease.
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