Is the chance of pregnancy high with an endometrioma (chocolate cyst)?

Endometriomas (also known as “chocolate cysts”) result from endometriosis—abnormal growth of endometrial-like tissue outside the uterus. Do women with endometriomas have a high chance of becoming pregnant?

Do women with endometriomas have a high chance of becoming pregnant?

In general, women with endometriomas face reduced fertility. This is because endometriomas often cause local adhesions involving the ovaries and fallopian tubes, thereby impairing conception. Indeed, many women diagnosed with endometriomas also experience infertility. However, those with smaller, recently developed endometriomas tend to retain relatively higher fertility potential.

An endometrioma forms when ectopic endometrial tissue—implanted outside the uterine cavity—is hormonally stimulated by ovarian sex hormones and continues to undergo cyclical shedding in sync with menstruation. However, this shed tissue cannot exit the body and instead accumulates within the ovary. Over time, repeated accumulation leads to progressive enlargement of a blood-filled cyst. The old, degraded blood within the cyst becomes thick, brownish, and chocolate-like in appearance—hence the term “chocolate cyst.” These cysts gradually enlarge and may rupture spontaneously during or after menstruation. Importantly, they are almost never malignant.
If an endometrioma grows significantly large upon diagnosis, prompt laparoscopic surgery is typically recommended. Following surgical removal of the endometrioma, adjunctive treatment with intramuscular leuprolide acetate is often administered to suppress residual disease activity. After completing this therapy and discontinuing medication, patients may proceed with preconception planning and attempt pregnancy.

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