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Review
. 2025 Jan 23;15(2):161.
doi: 10.3390/life15020161.

A Narrative Review Regarding Implication of Ovarian Endometriomas in Infertility

Constantin-Cristian Văduva  1   2 , Laurențiu Dîră  1   2 , Lidia Boldeanu  3 , Mircea-Sebastian Șerbănescu  4   5 , Andreea Carp-Velișcu  6
Affiliations
Review

A Narrative Review Regarding Implication of Ovarian Endometriomas in Infertility

Constantin-Cristian Văduva et al. Life (Basel). .

Abstract

Endometriosis is a multifaceted gynecological disorder defined by endometrium-like tissue outside the uterine cavity. It is mainly localized in the pelvis and creates a local inflammatory environment responsible for its manifestations and complications. In 30-50% of cases, endometriosis is associated with infertility. In 17-44% of cases, the ovaries are affected in the form of ovarian endometriomas (OEs). The symptoms of OEs are not very pronounced. The development is slow. Diagnosis is difficult because OEs resemble cystic ovarian pathology, which is so diverse. The actual diagnosis is possible through direct visualization or laparoscopy. Surgical treatment by cystectomy is common for OEs. Recently, other therapeutic modalities have emerged that have less impact on ovarian reserves and pregnancy rates. In this context, the review attempts to shed light on the best diagnostic and treatment methods for an insidious pathology with a major impact on fertility.

Keywords: endometriosis; in vitro fertilization (IVF); infertility; ovarian endometriomas (OEs); ovarian sclerotherapy.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Color-coded stimulated follicles in the IVF cycle: (a) right ovary with normally growing follicles, (b) in the left ovary the arrows show an ovarian endometrioma compressing the follicles—vaginal 3D ultrasound with SonoAVC software (SonoAVC, automatic volume calculation: GE Medical Systems).
Figure 2
Figure 2
Vaginal ultrasound image of the ovary. The arrows show the ovarian endometrioma with ground-glass appearance.
Figure 3
Figure 3
The arrow shows an ovarian endometrioma that has developed in the ovary and is centrally covered by the fallopian tube laparoscopic image. Suspected diagnosis based on the chocolate content and pathological confirmation by a tissue sample.
Figure 4
Figure 4
Microscopic findings in ovarian endometriosis using hematoxylin and eosin (H&E) staining. (A) Invagination of the ovarian cortex with colonization by endometrial-like epithelial cells (arrow), magnification 4×. (B) Early-stage endometriosis localized to the ovarian cortex; arrows highlight endometrial-like glands, magnification 10×. (C) Advanced cortical endometriosis characterized by stromal alterations that followed glandular changes (arrows), magnification 5×. (D) Medullary endometriosis (arrow) involving deeper ovarian layers, magnification 4×. (E) Hemorrhagic ovarian endometrioma displaying hemosiderin-laden macrophages (arrow) and degenerating blood components, magnification 4×. (F) Inclusion cyst shown for comparison, lacking endometrial-like epithelial lining (arrow), magnification 4×.
Figure 5
Figure 5
Vaginal ultrasound image of an ovarian endometrioma treated by sclerotherapy: (a) Arrow shows the original aspect of the endometrioma (b) Arrows show the endometrioma 6 months after ethanolic sclerotherapy. A considerable reduction in size can be seen.
See this image and copyright information in PMC

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