be equally effective in regard to using a gnrh antagonist protocol in terms of pregnancy rate. on the other hand, when using a gnrh agonist protocol, long-term (three to six months) pituitary down-regulation before ivf for those with endometriosis has been estimated to increase the odds of clinical pregnancy by fourfold. no difference has been found between surgery (cystectomy or aspiration) versus expectant management, or between ablation versus cystectomy, prior to ivf in women with endometriosis. utilizing ivf procedures prior to endometriosis-associated surgery has not been shown to enhance fertility compared to utilizing ivf procedures post-surgery. epidemiology specific risk factors are still undetermined; however, genetic and environmental factors have been found to be associated with endometriosis, with genetic risk factors accounting for about 51% of endometriosis cases. genetic risk factors associated with endometriosis include: earlier menarche (≤11 years of age) short menstrual cycles (≤27 days) higher follicular-phase estradiol levels in taller women lower bmi first-degree relative with endometriosis environmental risk factors include: exposure to ovarian hormones. early life risk factors found correlated with increased risk for endometriosis include: low birth weight (under 2.5 kg or 5.5 lbs). higher physical activity levels and a diet with omega-3 fatty acids may reduce inflammatory markers, and decrease the risk of endometriosis.