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Ovarian endometrioma is a benign, estrogen-dependent cyst found in women of reproductive age. Infertility is associated with endometrioma; although the exact cause is unknown, oocyte quantity and quality are thought to be affected.  Endometrioma also known as “chocolate cyst” usually present as a pelvic mass arising from growth of ectopic endometrial tissue within the ovary. They typically contain thick brown tar-like fluid and are often densely adherent to surrounding structures, such as the fallopian tubes and bowel.


Endometriosis is a disorder in which the endometrium grows outside your uterine cavity. The endometrium is the tissue which makes up the inside surface of your uterus.   Endometriosis occurs when this lining grows on the ovaries, bowel, and tissues lining your pelvis. The misplaced endometrial tissue follows the menstrual cycle under the influence of hormonal changes. This means the tissue will grow, thicken, and break down.  This causes irritation, scar formation, or adhesions with the surrounding tissues. It may lead to severe pain during your periods and possible fertility problems

 Endometrioma and Fertility

The reason for why ovarian endometrioma causes infertility is unknown. In cases of severe endometriosis, infertility is associated with adhesions, tubal blockage and anatomical distortion.  Overall, how ovarian endometrioma causes infertility is not well understood.   Infertility caused by endometrioma is associated with reduced oocyte quantity and quality, but not embryo quality.


Endometriomatic cysts do not respond well to medical therapy and surgery is the best treatment for resolution. Several surgical techniques are available. Endometriomatic cysts can be treated by either ovarian cystectomy or draining and ablation of the cyst wall.

Causes of Endometriosis

During a regular menstruation, your body sheds the lining of your uterus. This enables menstrual blood to flow from your uterus through the small opening in the cervix and out through your vagina.  However, in endometriosis, menstrual blood flows back through the fallopian tubes into the pelvic cavity.   The displaced endometrial cells then stick to your pelvic walls and surfaces of pelvic organs. They then continue to grow, thicken, and bleed over the course of your menstrual cycle.  There are four main stages of Endometriosis: subtle, typical, cystic ovarian, and deep endometriosis.


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