STUDY QUESTION: What is the current management of women with ovarian 
endometriomas undergoing assisted reproductive treatment (ART) in the UK?
SUMMARY ANSWER: It appears that the majority of gynaecologists in the UK offer 
surgery (mostly cystectomy) for endometriomas prior to ART, regardless of the 
presence of symptoms.
WHAT IS KNOWN ALREADY: The ideal management of endometriomas in women undergoing 
ART remains controversial and presents a dilemma to reproductive specialists.
STUDY DESIGN, SIZE AND DURATION: This was a national cross-sectional survey. A 
total of 388 gynaecologists completed the questionnaire.
PARTICIPANTS, SETTINGS AND METHODS: All clinicians fully registered with the 
Royal College of Obstetricians and Gynaecologists were contacted. An 11-item 
survey was administered electronically using Survey Monkey software. 
Quantitative data were analysed using descriptive and comparative statistics.
MAIN RESULTS AND THE ROLE OF CHANCE: The majority of responders were consultants 
(65%), 25% practiced ART and 65% performed laparoscopic surgery. Overall, 95% of 
responders would offer surgery for endometriomas in women undergoing ART, either 
on the basis of the size (>3-5 cm) of the endometrioma (52%), the presence of 
symptoms (16%), the presence of multiple/bilateral endometriomas (2%), 
regardless of the size and symptoms (19%) or only to women undergoing IVF (6%). 
The remaining 5% of responders would not offer surgery before ART. Excision was 
the most common surgical modality (68%), followed by ablation (25%). 
Laparoscopic surgeons were almost twice as likely to 'offer surgery to all 
patients with endometriomas prior to ART' compared with clinicians performing 
laparotomy (22 versus 12%, P < 0.001).
LIMITATIONS, REASONS FOR CAUTION: Our overall response rate, with answers to the 
questionnaire, was low (15%). However, the response rate amongst reproductive 
specialists was estimated at 60%. It is possible that there might have been an 
element of bias towards over-representation of responders who are more concerned 
about 'normalization' of the pelvic anatomy. Furthermore, our survey relied on 
self-reporting of practice and it is possible that being presented with a list 
of 'ideal' options may have resulted in respondent bias.
WIDER IMPLICATIONS OF THE FINDINGS: Despite the available evidence that surgery 
for endometriomas does not improve the outcome of ART and may damage ovarian 
reserve, it seems that the majority of gynaecologists in the UK offer ovarian 
cystectomy to their patients.