Endometriotic cyst? IVF and surgery ? A new review challenges the routine removal of ovarian endometriomas before assisted reproductive technology (ART). Evidence shows that surgery can reduce ovarian reserve (lower AMH and fewer eggs) without improving pregnancy or live birth rates. In fact, women who skip surgery often require less medication and face fewer cycle cancellations. Guidelines remain inconsistent, but the trend is toward individualised care: reserve surgery for large (>4 cm) or pai