Figure 1: The generation of an ovarian endometrioma as observed in Trans Vaginal Hydrolaparoscopy confirming Sampson hypothesis for pathogenesis. a. Implantation of regurgitated endometrial cells during menses via tube on ovarian surface b. Persistent inflammation Neoangiogenesis, lesion spreading Bleeding at implantation site c. Chronic inflammation causes adhesions, cortex invagination and endometrioma formation Glob J Reprod Med 1(3): GJORM.MS.ID.555564 (2017) 001 Abstract Endometrioma

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... y and hemostasis negative affect ovarian reserve. The size of the endometrioma and the surgical technique are the most determining factors preserving ovarian function. Stripping the endometrioma pseudocapsule is detrimental for healthy ovarian tissue, reduces the risk of recurrence, however, not appropriate for infertility patients undergoing ART. Fenestration and laser vaporization of an endometrioma seems to minimally destruct the healthy ovarian tissue, offering the best surgical treatment option to infertility patients.