Ovarian chocolate cysts larger than 3 cm in diameter require complete surgical removal, most often a conservative laparoscopic procedure to preserve the patient’s reproductive function, remove as many ovarian endometriotic cysts as possible, and separate pelvic adhesions. The procedure can be performed by laser, electrocoagulation and cautery to destroy the cyst wall or by endometriosis cyst debridement. In cases of combined infertility, hysteroscopy and tubal laparoscopy may be performed. Ovarian ectopic cyst debridement is the procedure of choice. If the cyst is large and the adhesions are too tight to be peeled off, partial ovariectomy is feasible; if the ovarian tissue has been completely destroyed by ectopic endometrial tissue and the adhesions are too severe for partial ovariectomy, ovarian excision is feasible.