Objectives : Assessment of the outcomes of surgical management of ovarian endometrioma (OMA) regarding ovarian reserve (OR), endometriosis-induced manifestations, and recurrence rate (RR).   
Patients : 90 women with uniloculus OMA of >3 cm diameter in infertile women with good OR were randomly divided into three (A-C) groups according to the procedure: laparoscopic cystectomy, laparoscopic cyst evacuation and cauterization of the endocytic wall, and transvaginal aspiration and ethanol sclerotherapy. Serum anti-Müllerian hormone (AMH) and antral follicular count (AFC) were determined as baseline and 3-m and 6-m postoperative (PO). The study outcome is the impact of the applied procedures on OR, pain scores and consumption of analgesia, and the RR of OMA.
Results: The applied procedures significantly reduced pain scores and frequencies of patients according to the type of pain and analgesia consumed. At 3-m PO, serum AMH levels were decreased with non-significant differences in the percentage of decrease between the three groups. At 6-m PO, serum AMH levels were increased in Group-C patients, while progressively decreased in Group-B and did not change in Group-A patients. The decrease of AFC was maximal in group B with significantly lower counts than other groups that showed non-significant differences. Nineteen cases (21.1%) developed recurrent cysts with significantly lower RR in Group-A than in other groups.
Conclusion: No procedure was immune to disadvantages, thus proper evaluation of patients' concerns is mandatory. Transvaginal aspiration with sclerotherapy is appropriate if the pain is the main concern, while cystectomy was advocated to reduce recurrence, but for infertility management, no procedure was advantageous.