Laparoscopic cystectomy of endometrioma: Good surgical technique does not adversely affect ovarian reserve

Bhat, Rani Akhil; Dhulked, Sushma; Ramachandran, Amar; Bhaktha, Rajesh; Vasudeva, Akhila; Kumar, Pratap; Rao, Anjali

doi:10.4103/0974-1208.138871

Cited by 17 publications

(13 citation statements)

References 19 publications

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“…Based on ultrasonographic findings (AFC, OvVol) and serum FSH levels, Bhat et al. also found that ovarian reserve did not show any significant changes at 1 month after laparoscopic cystectomy of endometrioma . In our study, no significant changes were found in either AFC or OvVol after cystectomy; however, a non‐statistically significant increase in the OvVol values was noted.…”

Section: Discussioncontrasting

confidence: 54%

One‐year follow‐up of ovarian reserve by three methods in women after laparoscopic cystectomy for endometrioma and benign ovarian cysts

Kostrzewa

Wilczyński

Głowacka

et al. 2019

Intl J Gynecology & Obste

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Objective:To determine the long-term impact of laparoscopic cystectomy for endometriomas and benign cysts on ovarian reserve and selection of the most effective method of assessment. Methods:The present study was carried out between November 2013 and December 2016. Participants were assigned to laparoscopic cystectomy for diagnosed unilateral benign ovarian cysts and divided into groups: the endometrioma group (EG) (n=35) and the other benign ovarian tumor group (OG) (n=35). Before and at 3 and 12 months after the procedure, transvaginal ultrasonography was performed to assess antral follicle count (AFC) and ovarian volume (OvVol); laboratory tests were ordered for anti-Műllerian hormone (AMH) serum concentration assays. Pregnancy rates were counted in a 12-month follow-up. Statistica12 software was used for analysis. Results:The present study included 70 women aged 18-40 years. AMH serum concentration decreased significantly 3 months after laparoscopic cystectomy (4.89 ± 3.66 ng/mL to 3.45 ± 3.37 ng/mL; P<0.001). A greater decrease of AMH concentrations was observed in the EG (45.39% vs 14.87%; P=0.021). Twelve months of observation revealed a suppression in the drop of the AMH concentration, while AFC and OvVol remained unaffected. The likelihood of spontaneous pregnancy was three times higher in the OG (hazard ratio [HR] 3.57, 95% confidence interval [CI] 1.08-12.5). Conclusion:There was a significant decline in AMH levels in the EG 3 months after cystectomy. No further fall in AMH concentration was observed in the 12-month follow-up. The serum AMH concentration could be considered a valuable marker for ovarian reserve assessment after laparoscopic cystectomy. K E Y W O R D S

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Section: Discussioncontrasting

confidence: 54%

One‐year follow‐up of ovarian reserve by three methods in women after laparoscopic cystectomy for endometrioma and benign ovarian cysts

Kostrzewa

Wilczyński

Głowacka

et al. 2019

Intl J Gynecology & Obste

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“…According to the data from different studies, both laparoscopic techniques lead to reduction in ovarian volume and AFC as ultrasonographic markers for ovarian reserve. Several reports comparing cystectomy with puncture and endocoagulation have demonstrated that ablation was associated with a higher recurrence rate and lower cumulative pregnancy rate ( 2 , 3 , 4 , 5 , 6 , 7 ).…”

Section: Introductionmentioning

confidence: 99%

Effect of Two Laparoscopic Techniques for Treatment of Ovarian Endometrioma on Ovarian Reserve

Georgievska

Sapunov

Cekovska³

et al. 2015

Med Arh

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Introduction:Operative laparoscopy is the most common used technique for treatment of patients with ovarian endometriomas, because of many positive effects in comparison with laparotomy. There are many laparoscopic techniques, but most used are cystectomy and puncture with endocoagulation (ablation) of the cyst’s capsule. The aim of this study was to evaluate the effect of two laparoscopic techniques for treatment of ovarian endometriomas on ovarian reserve. We used two ultrasonographic markers for ovarian reserve: ovarian volume and antral follicle count (AFC).Materials and Methods:Sixty patients in reproductive age (18-42 years) were treated for a chronic pelvic pain or infertility in a tertiary hospital (University Clinic for Gynecology and Obstetrics in Skopje, R. Macedonia). The study was prospective and two laparoscopic techniques were used. All patients were with confirmed ultrasound diagnosis for ovarian endometriomas with diameter between 3 and 8 cm. Complete cystectomy was done in 30 patients (group A) and puncture with endocoagulation was done in other 30 patients (group B). Ovarian reserve was analyzed before surgery and was controlled one and three months after laparoscopic surgery.Results:In group A (operated with cystectomy) ovarian volume was 53.46±29.97 cm³ before surgery, which fell to 13.06±7.34 cm³ after one month, and 13.28±7.17 cm³ after three months. Statistical analysis showed a significant reduction in ovarian volume one and three months after surgery (p≤0.01). In group B (operated with puncture and endocoagulation) the ovarian volume was 58.34±37.99 cm³ before surgery, which fell to 18.96±7.90 cm³ one month and 17.38±6.86 cm³ three months after surgery. In both groups there was a significant reduction in ovarian volume one and three months postoperatively (p≤0.01). In the first group AFC was 3.03±1.27 before surgery, 4.8±1.30 one month after surgery and 6.23±1.57 after three months. Statistical analysis showed a significant increase in AFC after laparoscopic cystectomy (p≤0.01). In the second group AFC was 3.07±1.05 before surgery, 5.33±1.60 after one month and 7.0±1.62 after three months. The comparison of AFC showed high statistically significant difference (p≤0.001), e.g. increase of AFC after one and three months in comparison with AFC before surgery.Conclusions:Ovarian reserve decreases after laparoscopic surgery using both laparoscopic techniques. But, this decrease was more frequent using cystectomy in comparison with ablation of the endometriotic cyst.

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“…A study by Bhat et al 16 including 73 patients who underwent laparoscopic cystectomy demonstrated an insignificant decline in the AFC 1 month postoperatively. The observation of this study was in contrast to our study that showed statistically significant decline in AFC of the operated ovary postoperatively.…”

Section: Discussionmentioning

confidence: 98%

Size of Endometrioma and Number does Influence the Ovarian Reserve: A Prospective Observational Study

Sandya¹,

Kumar

2016

International Journal of Infertility &Amp; Fetal Medicine

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Background Endometriosis is one of the most commonly encountered benign problems in gynecology. Ultrasound and endocrine parameters have been widely accepted as markers of ovarian reserve. Anti-Mullerian hormone (AMH) in conjugation with antral follicle counts is now believed to be an excellent measure for detecting ovarian reserve. Surgical approach has a fundamental role in the management of endometriosis. The loss of normal follicles can be studied by histopathological assessment of the cyst wall. The postoperative decline in the ovarian reserve is believed to have a correlation with number of endometriomas and diameter of the cyst wall. Objective This prospective observational study was undertaken to evaluate the effect of laparoscopic cystectomy with respect to number and size of the cyst on ovarian reserve parameters. Materials and methods Fifty patients undergoing laparoscopic endometrioma cystectomy were analyzed. Cysts of <5cm and >5cm and the number of cysts were studied. Statistical analysis was done using Mauchly's test of sphericity. Anti-Mullerian hormone and antral follicle count were estimated prior to and 1 month after surgery. Pre- and postoperative values were compared and analyzed with respect to number and size of endometrioma. Observation and results There was an overall drop of AMH from 3.8 ± 3.01 to 2.67 ± 1.92 ng/ml (p < 0.001). The mean AMH in bilateral and unilateral endometrioma was 2.9 ± 1.7 and 3.9 ± 3.17 ng/ml respectively. Anti-Mullerian hormone dropped from 4.53 ± 3.4 to 3.19 ± 2.18 with <5 cm cyst compared with 2.4 ± 1.2 to 1.7 ± 0.85 with >5 cm cyst (p < 0.01). Overall drop in AFC was 5.17 ± 1.44 and 3.61 ± 1.61 pre- and postoperative respectively (p < 0.01). Mean drop in AFC was 2.2 and 1.2 in cyst <5 and > 5 cm respectively. Histopathological analysis showed loss of follicles in 25% of the cyst walls. This was correlating with the drop in both AMH and AFC postoperatively. Conclusion Size and number of cyst does affect ovarian reserve to the effect that smaller and bilateral cyst leads to a greater decline in the same. How to cite this article Sandya MR, Kumar P. Size of Endometrioma and Number does Influence the Ovarian Reserve: A Prospective Observational Study. Int J Infertil Fetal Med 2016;7(1):14-18.

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Laparoscopic cystectomy of endometrioma: Good surgical technique does not adversely affect ovarian reserve

Cited by 17 publications

References 19 publications

One‐year follow‐up of ovarian reserve by three methods in women after laparoscopic cystectomy for endometrioma and benign ovarian cysts

One‐year follow‐up of ovarian reserve by three methods in women after laparoscopic cystectomy for endometrioma and benign ovarian cysts

Effect of Two Laparoscopic Techniques for Treatment of Ovarian Endometrioma on Ovarian Reserve

Size of Endometrioma and Number does Influence the Ovarian Reserve: A Prospective Observational Study

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