Effect of laparoscopic excision of endometriomas on ovarian reserve: serial changes in the serum antimüllerian hormone levels

Çelik, Hale Göksever; Dogan, Erbil; Okyay, Emre; Ulukuş, Çağnur; Saatli, Bahadır; Uysal, Sezer; Koyuncuoğlu, Meral

doi:10.1016/j.fertnstert.2012.03.027

Cited by 164 publications

(156 citation statements)

References 24 publications

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“…These findings are consistent with the broader literature on this issue of ovarian reserve after laparoscopic surgery for endometrioma [4,7,9,12,23]. Nevertheless, we suggest that the question as to whether cystectomy reduces ovarian reserve has yet to be conclusively answered by findings from high-quality studies.…”

Section: Discussionsupporting

confidence: 90%

Laparoscopic Ovarian Cystectomy versus Fenestration/Coagulation or Laser Vaporization for the Treatment of Endometriomas: A Meta-Analysis of Randomized Controlled Trials

Dan

Lin²

2013

Gynecol Obstet Invest

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Aim: To compare outcomes after laparoscopic ovarian cystectomy versus fenestration/coagulation or laser ablation for the treatment of endometriomas. Methods: Studies were identified by searching the PubMed, EMBASE, SCOPUS, and Cochrane Central Register of Controlled Trials databases using the terms ovarian, endometrioma or endometriosis, cystectomy, fenestration, coagulation, laser, and ablation or vaporization. The outcomes of interest were recurrence of signs/symptoms and endometrioma, reoperation, pregnancy, and ovarian reserve. Results: Seven studies were included. The risk of recurrence of signs/symptoms after surgery was significantly lower for laparoscopic cystectomy compared with fenestration/coagulation [risk ratio (RR): 0.29; 95% CI: 0.15-0.55; I² = 0%; p < 0.001], as was the risk of recurrence compared with fenestration/coagulation (RR: 0.50; 95% CI: 0.26-0.97; I² = 0%; p = 0.04) and laser vaporization (RR: 0.33; 95% CI: 0.12-0.88; I² = 0%; p = 0.03). The risk of pregnancy was significantly higher for cystectomy compared with fenestration/coagulation (RR: 2.64; 95% CI: 1.49-4.69; I² = 0%; p < 0.001), but not laser vaporization (RR: 0.92; 95% CI: 0.30-2.80; p = 0.89). There were inadequate data for the meta-analysis of ovarian reserve. Conclusions: Our findings suggest that cystectomy provides better outcomes than fenestration/coagulation or laser ablation regarding recurrence of symptoms and endometrioma as well as pregnancy rate (fenestration/coagulation only). Further studies are needed to clarify the effect of these surgical approaches on ovarian reserve.

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Section: Discussionsupporting

confidence: 90%

Laparoscopic Ovarian Cystectomy versus Fenestration/Coagulation or Laser Vaporization for the Treatment of Endometriomas: A Meta-Analysis of Randomized Controlled Trials

Dan

Lin²

2013

Gynecol Obstet Invest

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“…If excision exerts a qualitative effect in the same way as a quantitative effect, relatively long interval (median; 22 months) between surgery and COS in the present study might explain no qualitative difference between oocytes from endometrioma-excised and healthy ovary. However, in contrast to the paper by Sugita, some authors reported no recovery from quantitative damage exerted by excision of endometrioma, though their observation period were shorter than 12 months [29,30]. The mechanisms by which the excision of endometrioma affects the ovarian function, together with whether the effect is temporal or sustained or even progressive, remain to be elucidated.…”

Section: Discussionmentioning

confidence: 75%

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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“…Even at the hand of skilled surgeon there is a progressive decline of AMH after endometriotic cystectomy. 54 Cyst drainage and coagulation cause less harm than cystectomy, but recurrence rate is higher than cystectomy. 16,17 Recently surgeons are trying to modify the surgical technique to protect the ovarian reserve.…”

Section: Discussionmentioning

confidence: 99%

Endometrioma is a Responsible Factor for Reduced Ovarian Reserve

Begum

Ehsan²,

Ehsan³

et al. 2016

Bangladesh J Obstet Gynaecol

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Objective (s): The aim of the study was to assess ovarian reserve (OR) of patients with endometrioma and to explore the differences of ovarian reserve in age matched group of infertile patients without endometrioma.Materials and methods: This prospective analytic study was done in Infertility Care and Research Center, between January 2013 and December 2015 to assess the ovarian reserve of patients with endometrioma. During this period 105 patients of endometriosis with endometrioma were selected for study. Selection criteria were: no history of previous surgery, <36 years of age, no history of endocrine problems, no history of recent medical treatment for this condition within 6 months and no history of irregular menstruation. For ovarian reserve testing we assessed serum FSH, E2 and AMH. Patient of same age group who had no emdometrioma, no history of any surgery, no menstrual irregularity, endocrine disorder or any other medical diseases were taken as control to compare the ovarian reserve between these two groups. For control group also we did the same tests. Data was analyzed by SPSS package. One-way ANOVA test was done for test of significance. A p-value of <0.05 was considered as significant.Results: There was no difference in characteristics of patients of both groups regarding age, type of infertility and duration of infertility. Size of the endometriotic cysts were variable and average diameter of cyst was 6.2 ±2.32 cm. Most (58.10%) of the cysts were unilateral. There is a significant difference of FSH and AMH level between the groups. FSH of endometrioma and non-endometrioma group was 7.9 ±1.17 and 7.1 ±1.05 mIU/mL respectively with a p value of 0.029. Similar difference was present in AMH level, which was 2.42 ±.63 and 2.98 ±.88 ng/ mL in endometrioma and non-endometrioma group respectively with a p value of 0.020.Conclusion: This small study shows a reduced ovarian reserve in patients with endometrioma in comparison to patients of same parameters without endometrioma. It suggests that there is an association of presence of ovarian endometrioma and reduced ovarian reserveBangladesh J Obstet Gynaecol, 2015; Vol. 30(2) : 98-104

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Effect of laparoscopic excision of endometriomas on ovarian reserve: serial changes in the serum antimüllerian hormone levels

Cited by 164 publications

References 24 publications

Laparoscopic Ovarian Cystectomy versus Fenestration/Coagulation or Laser Vaporization for the Treatment of Endometriomas: A Meta-Analysis of Randomized Controlled Trials

Laparoscopic Ovarian Cystectomy versus Fenestration/Coagulation or Laser Vaporization for the Treatment of Endometriomas: A Meta-Analysis of Randomized Controlled Trials

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

Endometrioma is a Responsible Factor for Reduced Ovarian Reserve

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