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Surgery
In younger women with unfulfilled reproductive potential, surgical treatment attempts to remove endometriotic tissue and preserve the ovaries without damaging normal tissue. Ideally, surgery would be performed to diagnose while simultaneously treating. This can minimize exposure to multiple surgeries

Surgery is more effective for infertility than hormonal suppression for endometriosis. Surgery enhances the chances of conceiving naturally during the 12-18 ensuing months. Ongoing hormonal suppression therapy after surgery can reduce the risk of recurring lesions and pain symptoms.

A surgeon must take into account the effect on ovarian reserve. Bilateral versus unilateral cystectomy of endometriomas can reduce ovarian reserve, as well as recurrent endometrioma excisions.

In cases of severe endometriosis, lesions may or may not be limited to the pelvic area, and may require imaging in order to create a more accurate surgical plan.

Mechanism

Women with endometriosis show increase in inflammatory markers in their peritoneal fluid, specifically within the pelvic area. Altered peritoneal fluid that surrounds ovaries can damage oocytes, and can be toxic to an embryo.