الفهرس 
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Abstract
Since the mid-20th century multiple social factors have contributed to postponement of maternity. the association between endometriosis and infertility is still not clear although worse results of assisted reproductive technique (ART) procedures are expected in patients with endometriosis.
Endometriosis is a chronic gynecologic condition in which endometrial glands and stroma exist outside the uterus they are predominately found in the pelvis, but may be present anywhere in the body. This ectopic endometrium can cause scarring, as well as produce pain-mediating factors (e.g. Prostaglandins) that contribute to symptomatology. Some women with endometriosis are asymptomatic, while others can suffer infertility, incapacitating chronic Pelvic pain, severe dysmenorrhea, and dyspareunia. The prevalence of endometriosis in reproductive age women is approximately 11 percent, although the estimates are higher for those with infertility (38 percent) and women with chronic pelvic pain (71 to 87 percent).
Laparoscopy has become both the diagnostic and therapeutic tool for managing this disease. The primary goal is to remove all visible lesions and adhesions, thereby restoring normal pelvic anatomy. Various surgical techniques have been described, ranging from excision to ablation. In some instances, destruction of nerve pathways, thought to be carrying pain fibers from the pelvis, is also used (i.e., uterine nerve ablation and presacral neurectomy.
This prospective controlled study was conducted in the department of Obstetrics and Gynecology, Faculty of Medicine, El-Minia University during the period from January 2015 to October 2018.
Fourty four (44) patients were recruited for this study. All patients were submitted to laparoscopic excision of ovarian endometrioma(s) .The aim and technique of the study were simply explained to the patients, and a formal consent was taken from all patients, confirming their free approval.
The recruited women were subjected to:-
Detailed history taking,, General examination,, ) Abdominal and pelvic examination,, ) Trans – vaginal ultrasound examination Scanning for both adnexa was done to detect any pathology that could had been missed during clinical examination that confirming presence of ovarian endometrioma which was mainly a unilocular tumor and has a low level echogenicity representing old blood in the cyst cavity (commonly termed ground glass) ) Laboratory assay:- Blood samples were obtained from all patients. Serum Anti-mullerian hormone level, basal serum level of day 3 FSH and E2 were determined before the procedure. And 3 months after the procedure
6)All patients were submitted to operative laparoscopy for stripping of the ovarian endometrioma
Response evaluation was through:
1) Ovarian response (ovarian volume, number and mean follicular diameter),
2) Changes that occured in serum AMH, FSH and E2 levels.
3) Biochemical pregnancy rate, clinical pregnancy and ongoing healthy pregnancy.
Our current study resulted in:-
The number of AFC in the treated ovary was significantly increased from a median of 5 before surgery to 7 after three months (p <0.001). There was a significant reduction of ovarian volume from a median of 13 mL before surgery to 6 mL after three months (p <0.001).
On comparison of operative characteristics in patients with unilateral and bilateral lesions (Table 5), Bilateral lesion had significantly higher duration of surgery with a median of 128.5 minutes versus 82 minutes for unilateral lesions (p= 0.001). Bilateral lesions was associated with slightly non-significant higher levels of blood loss with a median of 110 mL versus 55 mL for unilateral lesions (p= 0.06).