Beyond the Mass Effect: Decoupling Endometrioma Size and Bilaterality from Ovarian Reserve Depletion

The authors investigate whether the size and bilaterality of ovarian endometriomas are reliable indicators of ovarian reserve depletion, challenging the traditional "mass effect" concept that links these anatomical features to greater ovarian damage. They highlight that recent studies show inconsistent relationships between cyst characteristics and ovarian reserve markers, suggesting that other factors, such as inflammation and oxidative stress, may play a more significant role in ovarian dysfunction. The paper calls for a more nuanced understanding of these mechanisms and advocates for individualized clinical decision-making based on a comprehensive assessment of symptoms and reproductive goals rather than solely on cyst morphology.