Introduction: 36 yo, nulligravid with history of infertility for 3 yrs. Failed IVF. She denies any pelvic pain, urinary or bowel symptoms. TVUS showed bilateral endometrioma and evidence of kissing ovaries.

Method:After entering the abdominal cavity, the ovaries were severely diseased from endometriosis. The bowel and omentum were adhered to the adnexa. These adhesions were gently separated by blunt dissection. The endometrioma spontaneously ruptured and the chocolate-colored contents were aspirated. Traction and counter - traction with laparoscopic graspers was used to peal off the entire cyst wall. Hemostasis was achieved by suturing the ovary together. By avoiding the use of thermal energy, ovarian reserve is protected. Despite the absence of any identifiable planes between the cyst wall and the ovarian tissue, the endometrioma was excised. Shaving technique was used to treat areas of endometriosis. The lesions of endometriosis on the pelvic side wall was resected. Specimens were removed using an Endobag.

Conclusion: Laparoscopic treatment of ovarian endometrioma has become the gold-standard. Restoration of the pelvic anatomy without compromising ovarian function results in excellent post-operative pregnancy rates by IVF.