The precise relationship between endometriosis and infertility is debated. 
Surgery is considered to play a role within the framework of the therapeutic 
options to cure infertile women with the disease even though its effectiveness 
is generally modest. In fact, there is unquestionably the need to improve 
surgical techniques in this area. Specifically, two main aspects require 
optimization: 1) preventing the injury to the follicular reserve that follows 
surgical excision of ovarian endometriomas and 2) preventing post-surgical 
formation and re-formation of adhesions. The comparison between the 
excision/stripping and the vaporization/coagulation techniques represents the 
main point of debate on what is the best procedure to remove ovarian 
endometrioma. Randomized controlled trials showed that the excision technique is 
associated with a higher pregnancy rate and a lower rate of recurrence although 
it may determine severe injury to the ovarian reserve. Improvements to this 
latter aspect may be represented by a combined excisional-vaporization technique 
or by replacing diathermy coagulation with surgical ovarian suture. Barrier 
agents reduce but not eliminate the post-surgical adhesion formation in women 
with endometriosis. Encouraging evidence has been reported with Interceed, 
Oxiplex/AP gel and Adept solution. However, available studies are mainly based 
on II look laparoscopies performed few weeks after the intervention and data on 
fertility is lacking. Clinical trials including pregnancy rate as a specific 
outcome are warranted.