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Simple fenestration with drainage of endometriomas carries a high risk of recurrence and is not recommended.8 Laparoscopy has significant advantages over laparotomy and may be associated with better pregnancy outcome among women with moderate endometriosis, including those with endometriomas. In vitro fertilisation is appropriate treatment for couples where the woman has endometriosis and other treatment options have failed or there is evidence of an associated infertility problem, such as a male factor.9 It is often recommended as an early treatment option for women with moderate or severe disease where there is a high chance of impaired tubal�Covarian anatomy. Meta-analysis10 suggests that the success rate of IVF is reduced among women with endometriosis compared with those with tubal factor [http://www.selleckchem.com/products/Bafilomycin-A1.html Baf-A1 chemical structure] infertility. However, this is not seen when large national databases are analysed and IVF is still considered a worthwhile option for women with endometriosis. A Cochrane meta-analysis24 suggests that downregulation with gonadotrophin-releasing hormone analogue for at [http://www.selleckchem.com/products/VX-809.html Lumacaftor] least 3 months before IVF can improve the live birth rate among women with endometriosis undergoing IVF. There are no randomised trials comparing laparoscopic excision or ablation with expectant management before cycles of IVF and intracytoplasmic sperm injection. Factors in favour of surgical treatment of endometrioma before IVF include the opportunity to confirm the diagnosis of endometrioma with histology, improved ease of monitoring [http://en.wikipedia.org/wiki/Resminostat Resminostat] and easier access to ovarian follicles for aspiration. The literature contains a number of reports of severe pelvic infection following egg collection from women with endometrioma. Although there are no trials investigating whether this can be prevented by surgical treatment of the endometrioma before IVF, this risk should be discussed with women with endometrioma who are preparing for IVF. Factors weighing against surgical treatment of endometrioma before surgery include the risk of surgical complications and the possibility of reducing ovarian reserve, as discussed previously. Expert guidelines recommend laparoscopic excision of endometriomas