Background: The endometriosis-mediated damage to ovarian re- serve beyond the stretching of ovarian cortex that can lead to loss  of primordial follicles is supported by many studies.Laparoscopy represents the first-line treatment in sub fertile women with endo- metriotic ovarian cysts. The primary benefit of surgical treatment of endometriosis is the relief o f pelvic pain. The effect of laparoscopic cystectomy of an endometrioma on the antral follicle count has been conflicting. Objective: is to estimate effects of laparoscopic ovarian cystectomy on ovarian reserve and ICSI outcome. Methodology: 100 patients with unilateral ovarian endometrioma (size from 2.5-5 cm) were selected for ICSI, divided into two equal groups, group1 (underwent laparoscopic cystectomy) and group2 (underwent ultrasound guided cyst aspiration). Both groups were compared regarding ICSI outcome (number of oocytes, number of embryos transferred, pregnancy rate) as well as change in AMH as a marker of ovarian reserve 6 months after the procedures. Outcome measures: the outcomes were the ovarian reserve changes after the two procedures as well as the Intracytoplasmic Sperm Injection out- comes. Results: There is a remarkable reduction in the level of AMH in group1(43% reduction) compared to group2 (5.7%) with no signifi- cance (P=0.393). Conclusion: In view of the hazardous effect of laparoscopic ovarian cystectomy on ovarian reserve, ultrasound guided aspiration may be a good alternative procedure for treatment of endometrioma in view of preserving the ovarian tissues without compromising ICSI outcomes