After more than ten years of IVF clinical treatment, I often encounter such questions: I have been infertile for many years, I have undergone surgery for endometriosis, pelvic adhesiolysis, electrocautery for ectopic lesions, tubal plastic surgery, etc., but I am still not pregnant and very distressed; I have ovarian chocolate cysts, and the doctor said it affects pregnancy; I have endometriosis for more than ten years, and I have repeated IVF many times, but I have not been I have had endometriosis for more than 10 years, and I have repeated IVF many times, but I have not been successful. In fact, ovarian chocolate cysts are a manifestation of endoheterozygosity, which currently accounts for about 30% of IVF patients with female factor, and the incidence of infertility in patients with endoheterozygosity is as high as 40-50%. The mechanisms of infertility caused by endoheterosis are as follows: 1) structural changes in the pelvis and structural and functional abnormalities of the fallopian tubes, which interfere with gamete or embryo transport; 2) ovarian chocolate cysts can impair the distribution of blood vessels in the ovary, reduce the ovarian response to gonadotropins and diminish the ovarian reserve; 3) interference with ovarian response, egg quality, fertilization, embryo quality and implantation through a wide range of other unknown secretory pathways, such as endo In patients with endoheterozygosity, macrophages, prostaglandins, and altered tumor necrosis factor in the peritoneal fluid lead to decreased egg quality, and decreased integrins in the endometrium and abnormal expression of leukemia inhibitory factors lead to decreased endometrial tolerance and interference with implantation. Treatment of infertility caused by endometriosis Drug therapy: Currently, GNRHa is mostly used for treatment. However, GNRHa alone will inhibit ovulation and is not advocated to be used alone, but mostly for pre-treatment of IVF. Most domestic and international studies have concluded that GNRHa treatment applied for 2 to 6 months prior to IVF can increase the rate of quality embryos, the rate of bed placement and reduce the rate of miscarriage in IVF. The clinical experience of our department for many years shows that patients with this regimen will have increased dosage of drugs required for ovulation promotion and decreased number of eggs obtained, and patients’ confidence will be undermined and they will think that my condition is very poor and there is little hope for success, etc. However, the final treatment results show that such patients can get similar clinical pregnancy rate and lower miscarriage rate as patients with tubal factors alone. Therefore, psychological counseling should be enhanced for such patients. Surgical treatment: Surgical excision of endometriosis lesions on the pelvic and abdominal surfaces may improve the toxic environment of the pelvis, but it leads to irreversible reduction of ovarian reserve and low efficiency with a pregnancy rate of 10-30% at one year postoperatively. Surgical treatment of asymptomatic 〈3 cm ovarian chocolate cysts may be unnecessary. Patients who require surgery should be fully evaluated for ovarian reserve and possible damage to the ovaries and patient tolerance before recommending surgery. IVF treatment: IVF treatment has become a major method of obtaining pregnancy in patients with endometriosis. Domestic and international studies have reported that the success rate of IVF in patients with endometriosis is slightly lower than that of patients with tubal factors alone, but there is no statistical difference. Patients with endometriosis, especially those with moderate to severe disease and those who have undergone surgery, may obtain a relatively low number of eggs, but this does not affect their pregnancy success rate. I once met a patient who had recurrent recurrences 10 years ago after surgical treatment at a famous obstetrics and gynecology hospital for giant uterine fibroids and giant ovarian chocolate cysts, and had undergone IVF several times without pregnancy, with extremely poor ovarian function. Later, she learned about our hospital from a patient and came to us with a glimmer of hope, but she was able to obtain only 1-3 eggs each time. Therefore, even if you have poor ovarian reserve, don’t lose confidence because of the low number of eggs and poor ovarian reserve, as long as you work hard, your efforts will be rewarded and your wish to be a mother will no longer be a dream.