Endometriomas and Fertility

Ovarian endometriomas can be relevant to fertility decisions. Endometriomas are ovarian cysts linked with endometriosis. They are sometimes called “chocolate cysts” because they can contain old blood. They may affect pain, ovarian tissue, ovarian reserve and fertility planning for some people. Not everyone with an endometrioma will have fertility problems, and not every endometrioma needs immediate surgery. Decisions should be individual.

Why endometriomas matter

Endometriomas can matter because they involve the ovary. They may be relevant to:

  • pelvic pain
  • pain during sex
  • ovulation pain
  • fertility planning
  • ovarian reserve
  • IVF planning
  • surgery decisions
  • monitoring over time
  • whether one or both ovaries are affected

The best plan depends on symptoms, cyst size, whether the endometrioma is changing, ovarian reserve, previous surgery, fertility goals and specialist advice.

Ovarian reserve

Ovarian reserve is a way of estimating how the ovaries may respond to fertility treatment. It does not tell the full story of fertility, but it can help guide decisions. Tests may include AMH blood testing and ultrasound assessment of follicle count, depending on local practice and individual circumstances. Ask whether ovarian reserve should be checked before treatment decisions, especially if surgery is being discussed or if both ovaries are involved.

Surgery considerations

Surgery for endometriomas may help some people, especially where there is pain, growth, uncertainty about the diagnosis, or fertility planning reasons. But surgery on the ovary can also affect healthy ovarian tissue and ovarian reserve. This is why specialist discussion is important before deciding. Ask what approach is being recommended, why, and how the surgeon will try to protect ovarian tissue where possible.

Monitoring

Some endometriomas may be monitored with follow-up and imaging. Others may need treatment. Monitoring may be considered when symptoms are manageable, imaging is reassuring, fertility plans do not require immediate intervention, or surgery risks outweigh likely benefits. Ask what size the endometrioma is, whether it is changing, how often it should be reviewed, and what symptoms should prompt earlier assessment.

Fertility treatment planning

If IVF or other fertility treatment is being considered, endometriomas should be discussed as part of the plan. Ask:

  • Should the endometrioma be treated before fertility treatment?
  • Could surgery delay treatment or affect ovarian reserve?
  • Could monitoring be safer in my situation?
  • How might the endometrioma affect egg collection or IVF planning?
  • Should fertility preservation be discussed?

The right sequence is individual. For some people, surgery may be helpful. For others, fertility treatment before surgery may be more appropriate.

Questions to ask

You may want to ask:

  • How large is the endometrioma?
  • Is one ovary or both ovaries involved?
  • Is it changing over time?
  • Should ovarian reserve be tested?
  • Could this affect fertility or IVF planning?
  • What are the risks of surgery?
  • What are the risks of monitoring?
  • Would excision, drainage, ablation or another approach be used?
  • How will healthy ovarian tissue be protected?
  • Should I see a fertility specialist before deciding?
  • What follow-up do I need?

Prepare before you speak with a healthcare professional

Use our Prepare for Appointment Tool to organise your symptoms, questions, fertility priorities, scan results, previous surgery history and concerns before your appointment. Try to record pain patterns, cycle symptoms, fertility goals, previous endometrioma history, whether one or both ovaries have been affected, and any fertility tests already done. You do not need a perfect diary. A clear summary can help the conversation feel more focused.

Finding the right type of care

Use the Endometriosis Care Directory to explore endometriosis-related care providers, including endometriosis specialists, fertility specialists and multidisciplinary clinics. The directory is for research and information only. It is not a recommendation, referral service, ranking or medical advice. Always check details directly with the provider and speak with an appropriate healthcare professional before making decisions about your care.

Final reminder

Endometriomas can be important in fertility planning, but decisions should be individual. You deserve clear information about cyst size, ovarian reserve, monitoring, surgery risks, fertility treatment options and follow-up before making decisions. This resource is here to support your understanding, not replace medical advice from a qualified healthcare professional.