The increased number of so called ‘unexplained infertility’ hides a high number of not diagnosed endometriosis due to the systematic omission of a diagnostic laparoscopy in the exploration of the infertile patients and a policy of a liberal referral to IVF programs. The question of patients after failed IVF, ‘Could I conceive without IVF if my endometriosis was properly diagnosed and treated?’ should stimulate a critical evaluation of the treatment policy. Endometriosis negatively affects reproductive outcomes after IVF treatments. Recent and old data clearly demonstrates the positive effect of endometriosis surgery not only in the relief of pain but also for obtaining spontaneous pregnancies. As the disease by itself negatively affects the ovarian reserve, utmost care should be while performing the surgery using latest technologies and it should be performed by well-trained surgeons with the required expertise.