title: Controversies in the management of endometriomas in patients undergoing assisted reproduction.
abstract: BACKGROUND
  The presence of an endometrioma has been proposed to affect the ovarian function in a negative way. Our aim was to present the key evidence on multiple aspects of endometriomas' management in subfertile couples scheduled for assisted reproduction technologies (ART).
  
  
  METHODS
  A critical review of the existing literature was performed focusing on the need of endometrioma treatment prior to ART, the relevant options, the potentially participating surgeon's characteristics and the socioeconomic perspective.
  
  
  RESULTS
  To date, we have no definitive data to suggest whether the damage to the ovaries observed in women with endometriomas may be related to the mere presence of the cyst, the surgical procedure to remove it, the combination of the two, or factors currently unknown. Moreover, there is no conclusive evidence that, for subfertile couples, removal of endometriomas increases the chance of having a baby. The uncertainty regarding the best treatment strategy and factors such as the limited number of tertiary centers for laparoscopic surgery throughout the world seems to further complicate the decision.
  
  
  CONCLUSIONS
  Until research addresses the current "grey areas", the management of endometriomas in patients undergoing ART should be individualized and take into consideration numerous parameters.
authors.affiliation: Assisted Reproduction Unit, 3rd Department of Obstetrics and Gynecology, University of Athens, Attikon Hospital, 1 Rimini Street, Chaidari, 12462, Athens, Greece.
authors.forename: Charalampos
authors.initials: C
authors.lastname: Siristatidis
authors.forename: Charalampos
authors.initials: C
authors.lastname: Chrelias
authors.forename: Vasileios D
authors.initials: VD
authors.lastname: Sioulas
authors.forename: Vasiliki A
authors.initials: VA
authors.lastname: Stathopoulou
authors.forename: George-Marios C
authors.initials: GM
authors.lastname: Makris
authors.forename: George
authors.initials: G
authors.lastname: Koliopoulos
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Kassanos
mesh_terms: D004715:Endometriosis / Q000150:complications / Q000628:therapy*; D005260:Female; D006801:Humans; D007247:Infertility, Female / Q000150:complications / Q000628:therapy*; D010051:Ovarian Neoplasms / Q000150:complications / Q000628:therapy*; D027724:Reproductive Techniques, Assisted