Endometrioma surgery and ovarian reserve, hydrosalpinx, septum, polyps and fibroids before transfer, recurrent implantation failure.
This page is written for clinicians and referrers and is not advice for individual patients. If you are a patient, the plain-language page is Fertility and miscarriage surgery .
Each week the literature is searched for new papers on surgery before IVF, screened to the few that meet the evidence bar, and each one is verified on PubMed before it is summarised. I read every entry and give one verdict: whether the paper changes what I tell patients or do in theatre, supports current practice, or leaves it unchanged. Papers appear here newest first, grouped by the week they were found, with the study design, the main result and its effect size, and the reason for the verdict. Abstracts are not reproduced; the summaries are my own.
Digest of 19 October 2026
Search window 13 to 19 October 2026
One in six women needs further surgery after an operation for ovarian endometriosis, one in three after ovarian-conserving surgery
Finnish national register cohort of 13,912 women whose first surgically verified diagnosis of ovarian endometriosis came with an ovarian procedure between 1987 and 2012, followed through the registers to 2019 (median 20.7 years).
Finding
The 30-year cumulative risk of any reoperation was 17.3% (about one in six) and of ovarian reoperation 16.5%, with a median 3.4 years to the first and under two years to each later one. Compared with oophorectomy, enucleation or resection carried a higher risk of any reoperation (aHR 1.43, 95% CI 1.28-1.60) and other ovarian procedures higher still (aHR 2.20, 95% CI 1.67-2.89); the authors put this at roughly one in three reoperated after ovary-conserving surgery against one in ten after oophorectomy. Young age, a family history of endometriosis, a primary diagnosis of endometriosis and prior infertility each raised the risk, and hysterectomy before or at the index operation lowered it. Reoperated women had fewer births (61.6% vs 70.7%) and more infertility (51.5% vs 17.1%); reoperation was more common after index surgery in 1996-2012 than in 1987-1995 (19.0% vs 12.4%), and by the fourth or later operation 13.4% of procedures were for deep infiltrating endometriosis.
Supports current practicestrong evidence
Gives long-term national figures for counselling before endometrioma surgery and backs an individualised, fertility-conscious choice between keeping and removing the ovary rather than any change in technique.
What it means
For a woman deciding about surgery for an endometrioma, this gives a figure I can quote: about one in six women needs another operation over the following decades, sooner in younger women, those with a family history and those with infertility, and keeping the ovary roughly trebles that chance compared with removing it.
Conflicts of interest: Funding not stated in the abstract.
Reviewed by Mr Jan, .
Vasopressin during endometrioma cystectomy speeds haemostasis but does not protect ovarian reserve: randomised trial
Single-centre randomised controlled trial at a Korean university hospital, September 2018 to July 2021: 75 women having laparoscopic cystectomy for a unilateral endometrioma, stratified by baseline AMH and randomised to vasopressin injection or no injection; the primary outcome was the change in serum AMH at 12 months, analysed by intention to treat and per protocol.
Finding
Vasopressin shortened bleeding control (2.2 vs 6.5 minutes, p = 0.002) and cyst stripping (8.9 vs 14.4 minutes, p = 0.054), but the fall in AMH at 12 months was the same in both arms (-0.96 vs -1.14 ng/mL, p = 0.488), with the same pattern in women with baseline AMH below 3 ng/mL and 3 to 7 ng/mL. AMH fell significantly at three months and partly recovered at six and twelve months in both groups (group-by-time interaction p = 0.816), and the specimens contained the same thickness and proportion of ovarian tissue in each group.
No changemoderate evidence
Vasopressin shortens the operation but should not be presented as protecting the ovary; the trial is small and single-centre, and it leaves the egg-sparing technique neither proven nor disproven.
What it means
For the woman having an endometrioma removed, the loss of ovarian reserve after cystectomy (AMH down by about 1 ng/mL at a year, with partial recovery from three months) happened whether or not vasopressin was used to reduce bleeding and diathermy.
Conflicts of interest: Funding not stated in the abstract.
Reviewed by Mr Jan, .
Thin endometrium lowers live birth on a gradient, and a trilaminar pattern partly offsets it: 45,729 transfer cycles
Retrospective cohort of 45,729 embryo transfer cycles (16,566 fresh, 29,163 frozen-thawed) between January 2018 and August 2022; the setting is not named in the abstract.
Finding
Live birth rose steeply with endometrial thickness, the slope flattening at about 11-12 mm in fresh and 9-10 mm in frozen cycles. A non-trilaminar (type B/C) pattern lowered adjusted live birth (fresh aRR 0.880, 95% CI 0.832-0.930; frozen aRR 0.892, 95% CI 0.863-0.923), and the pattern mattered most below 10 mm: in frozen cycles live birth ranged from 16.7% (under 7 mm, non-trilaminar) to 44.7% (14 mm or more, trilaminar), about 17 in 100 to about 45 in 100, and in some comparisons a thinner trilaminar lining outperformed the next thicker non-trilaminar one. Thickness and pattern varied with the stimulation protocol in fresh cycles and the preparation regimen in frozen ones.
Supports current practicemoderate evidence
Useful numbers for counselling Asherman's and thin-endometrium patients before transfer, confirming thinness is a graded rather than a threshold problem and that the trilaminar pattern carries weight; observational, so it cannot say whether treating the lining improves outcomes.
What it means
For a woman with a thin lining after Asherman's treatment, the chance of a live birth per frozen transfer rises steeply with thickness up to about 9 to 10 mm and then flattens, and below 10 mm a three-layer (trilaminar) pattern does better at any thickness.
Conflicts of interest: Funding not stated in the abstract.
Reviewed by Mr Jan, .
Every paper on this site's evidence pages is also available as open data at /evidence/papers.json. The search and screening rules are on the evidence index.
Last reviewed .Reviewed by Mr Haider Jan, Consultant Gynaecologist.
For patients: Fertility and miscarriage surgery
The plain-language page on what the condition is, how I assess it and the choices, written for the women I see.
