Does laparoscopic excision of endometriotic ovarian cysts significantly affect ovarian reserve? Insights from IVF cycles

Somigliana, Edgardo; Ragni, G.; Benedetti, Francesca; Borroni, Raffaella; Vegetti, Walter; Crosignani, P.G.

doi:10.1093/humrep/deg432

Cited by 174 publications

(131 citation statements)

References 18 publications

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“…Recent evidence suggests that laparoscopic cystectomy of an ovarian endometrioma reduces ovarian reserve and consequently the response to ovarian stimulation [12,[15][16][17][18]. Most of these reports compared the adverse effects of cystectomy on subsequent response to IVF treatments, such as the response to controlled ovarian hyperstimulation and the mean number of oocytes retrieved in operated versus non-operated patients [21,[27][28][29], but there were few A large endometrioma (≥4 cm in diameter) Fig.…”

Section: Discussionmentioning

confidence: 99%

“…Cystectomy is commonly performed on endometriomas more than 3 cm in diameter before ART treatment [12]. Some studies reported that endometrioma cystectomy had no detrimental effect on controlled ovarian hyperstimula-tion or on ART outcomes [13,14], while some other studies reported that endometrioma cystectomy reduced response to controlled ovarian hyperstimulation [15][16][17][18]. The authors report that reduced ovarian response and decreased ovarian reserve after cystectomy was directly affected by the surgery [15][16][17].…”

Section: Introductionmentioning

confidence: 99%

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The frequency of ovulation from the affected ovary decreases following laparoscopic cystectomy in infertile women with unilateral endometrioma during a natural cycle

Horikawa

Nakagawa

Ohgi

et al. 2008

J Assist Reprod Genet

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Purpose To evaluate the cystectomy-induced damage on the follicular growth and ovulation of an affected ovary during natural cycles. Methods Twenty-eight infertile patients with unilateral ovarian endometriomas who underwent laparoscopic cystectomy were retrospectively evaluated. The ovulation rate of an affected ovary during natural cycles was compared before and after cystectomy in each patient, and it was also determined if ovulation from the affected ovaries resulted in pregnancy.Results After surgery, the ovulation rate was significantly lower than that before cystectomy (16.9±4.5% vs. 34.4± 6.6%, P= 0.013). After surgery, 14 pregnancies were achieved without IVF treatment, and only 2 of them (14.3%) were achieved from an operated-side ovary. However, the pregnancy rate per ovulatory cycle of the operated-side ovary was not different from that of the intact ovary (8.8% vs. 5.8%, P=0.750). Conclusions Laparoscopic cystectomy is an invasive treatment in that it reduces the frequency of ovulation; however the pregnancy rate per ovulation did not deteriorate.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The frequency of ovulation from the affected ovary decreases following laparoscopic cystectomy in infertile women with unilateral endometrioma during a natural cycle

Horikawa

Nakagawa

Ohgi

et al. 2008

J Assist Reprod Genet

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“…10 It is revealed that; stripping of the cyst wall may result in ovarian reserve damage due to the removal of healthy ovarian cortex and thermal destruction of ovarian follicles by use of bipolar coagulation for bleeding, which commonly applied after stripping. 19,20 Hemostatic procedure after stripping of endometrioma might be one of the most important step in the operation. Ferrero et al showed through a randomized controlled trial that laparoscopic stripping of ovarian endometriotic cyst significantly decreases ovarian reserve [measured by means of serum anti Mullerian hormon (AMH) and basal FSH levels] independent from the method used to obtain hemostasis on the ovarian tissue (bipolar coagulation or suturing).…”

Section: Fshmentioning

confidence: 99%

The Effect of Unilateral Endometrioma Excision on Ovarian Reserve

Semiz¹,

Apı²,

Kayatas³

et al. 2015

Turkiye Klinikleri J Gynecol Obst

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M echanisms of infertility associated with endometriosis are controversial. It is hypothesized that endometriosis is associated with overproduction of prostaglandins, metalloproteinases, cytokines, Turkiye Klinikleri J Gynecol Obst 2015;25(2) 71 The Effect of Unilateral Endometrioma Excision on Ovarian Reserve A AB BS S T TR RA AC CT T O Ob bj je ec ct ti iv ve e: : To evaluate the effect of laparoscopic cystectomy for endometriomas on ovarian reserve as determined by antral follicle count (AFC) and follicle stimulating hormone (FSH) level. M Ma at te er ri ia al l a an nd d M Me et th ho od ds s: : In this prospective, observational, operated and non-operated site comparative study, twenty one women between 20-36 ages with previous history of laparoscopic surgery for unilateral ovarian endometriomas greater than 30 mm were called for the evaluation of ovarian reserve at third month. Only first endometrioma removal operations were included. Removal of endometrioma was performed by laparoscopic ovarian tissue-sparing stripping technique. AFC of both ovaries were evaluated on 2-5 day of postoperative third menstrual cycle by independent examiners, blinded to the clinical and surgical history of patients. AFCs of both ovaries were analyzed to compare between operated and non-operated sites. Pre and postoperative FSH levels were recorded also. R Re es su ul lt ts s: : There was statistically significant difference in the mean number of antral follicles in the operated side ovary (2.61±1.24) when compared to the non-operated side ovary (4.23±0.88) (p<0.001). Although a significant difference was found between pre and postoperative FSH levels (6.7±1.8 vs 6.9±1.6, p=0.011), this did not reach to clinical significance. C Co on nc cl lu u--s si io on n: : Our study results suggested that excision of endometriomas might have a negative impact on ovarian reserve as evidenced by a significant postoperative fall in ipsilateral AFC level.K Ke ey y W Wo or rd ds s: : Endometriosis; laparoscopy; follicle stimulating hormone; follicular fluid Ö ÖZ ZE ET T A Am ma aç ç: : Endometriyoma eksizyonu için yapılan laparoskopik kistektominin over rezervi üze-rine etkilerinin antral folikül sayısı (AFS) ve folikül stimülan hormon (FSH) seviyesi açısından değerlendirilmesi. G Ge er re eç ç v ve e Y Yö ön nt te em ml le er r: : Prospektif, gözlemsel, opere edilen tarafın opere edilmeyen tarafla karşılaştırıldığı bu çalışmada tek taraflı, 30 mm üzerinde ovarian endometriyoma nedeniyle laparoskopik operasyon geçirme öyküsü olan 20-36 yaş arası 21 kadın, operasyon sonrası 3. ayda çağrıldı. Sadece ilk kez ve laparoskopik stripping yöntemiyle endometriyoma ameliyatı geçirenler çal-ışmaya dâhil edildi. Her iki overin antral folikülleri, hastanın klinik ve operasyon öyküsüne kör bağımsız bir araştırmacı tarafından operasyon sonrası 3. ayda siklusun 2-5. günleri arası değerlendi-rildi. Her iki overin AFS'leri opere olan ve olmayan taraf arasında karşılaştırıldı. Pre ve postoperative FSH düzeyleri kaydedildi. B Bu ul lg gu ul la ar r: : Opere ol...

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“…Especially, comparing the affected ovary and the contra-lateral healthy ovary of the same women with a history of excision of unilateral endometrioma is an efficient way to assess the effect of excision. This study design was applied to evaluate the effect of excision of endometrioma in 6 reports so far [14][15][16][17][18][19]. Five of them reported the lower numbers of codominant follicles and/or retrieved oocytes in affected gonads, suggesting a quantitative effect of excision [15][16][17][18][19].…”

Section: Introductionmentioning

confidence: 99%

“…This study design was applied to evaluate the effect of excision of endometrioma in 6 reports so far [14][15][16][17][18][19]. Five of them reported the lower numbers of codominant follicles and/or retrieved oocytes in affected gonads, suggesting a quantitative effect of excision [15][16][17][18][19]. The fate of the retrieved oocytes, that is, a qualitative effect of excision, was assessed only in one paper by Ragni et al [17].…”

Section: Introductionmentioning

confidence: 99%

Laparoscopic excision of ovarian endometrioma does not exert a qualitative effect on ovarian function: insights from in vitro fertilization and single embryo transfer cycles

Harada

Takahashi

Hirata

et al. 2015

J Assist Reprod Genet

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Purpose To evaluate whether laparoscopic excision of endometrioma exerts a qualitative effect on ovarian function. Methods A retrospective analysis of oocytes retrieved in 25 cycles of 21 patients undergoing IVF treatment with controlled ovarian stimulation. The number of oocytes recovered from ovaries with a history of excision of endometrioma (EOv) were compared to those from contra-lateral healthy ovaries (H-Ov) as for the analysis of a quantitative effect of surgery. As for the analysis of a qualitative effect, 55 oocytes from E-Ov were compared to 128 oocytes from H-Ov in terms of normal fertilization rate and the rate of top-quality embryos per normally fertilized eggs. Furthermore, 10 embryos derived from oocytes recovered from E-Ov were compared to 24 embryos derived from oocytes from H-Ov in terms of clinical and on-going pregnancy rates per embryos in 34 single embryo transfer cycles. Results Mean number of oocytes recovered from E-Ov was significantly smaller than that from H-Ov (2.2±2.0 vs. 5.1± 3.3, P=0.009). There was no difference between oocytes from E-Ov and H-Ov as for normal fertilization rate (63.6 % vs. 69.5 %, P=0.43) and the rate of top-quality embryos (40.0 % vs. 49.0 %, P=0.34). Clinical and on-going pregnancy rates per embryos were also similar in embryos derived from oocytes recovered from E-Ov and H-Ov (40.0 % vs. 25.0 %, P= 0.39 and 20.0 % vs. 20.8 %, P=0.96).Conclusions The quality of oocytes recovered from the ovary with a history of laparoscopic excision of endometrioma is not inferior to the quality of oocytes from contra-lateral healthy ovary.

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Does laparoscopic excision of endometriotic ovarian cysts significantly affect ovarian reserve? Insights from IVF cycles

Abstract: Excision of endometriotic ovarian cysts is associated with a significant reduction in ovarian reserve. Further studies are required to clarify whether the damage is related to the surgical procedure or to the previous presence of a cyst.

Cited by 174 publications

References 18 publications

The frequency of ovulation from the affected ovary decreases following laparoscopic cystectomy in infertile women with unilateral endometrioma during a natural cycle

The frequency of ovulation from the affected ovary decreases following laparoscopic cystectomy in infertile women with unilateral endometrioma during a natural cycle

The Effect of Unilateral Endometrioma Excision on Ovarian Reserve

Laparoscopic excision of ovarian endometrioma does not exert a qualitative effect on ovarian function: insights from in vitro fertilization and single embryo transfer cycles

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