Ovarian Reserve Following Laparoscopic Ovarian Cystectomy vs Cyst Deroofing for Endometriomas

Sweed, Mohamed S.; Makled, Ahmed Khairy; Elsayed, Medhat Adel; Shawky, Mohamed; Abd-Elhady, Hamdy A.; Mansour, Ahmed M.; Mohamed, Radwa; Hemeda, Hosam; NasrElDin, Eman A.; Attia, Neveen S.; Eltaieb, E; Allam, Heba; Hussein, Ahmed

doi:10.1016/j.jmig.2018.06.022

Cited by 13 publications

(10 citation statements)

References 20 publications

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“…Lower rates of spontaneous pregnancy and higher rates of recurrence are associated with ablative surgery compared with cystectomy, whereas cystectomy was found to be deleterious for residual ovarian function (162,379,380). Since the meta-analysis of Dan et al in 2013 (380), RCTs comparing ablative versus excisional techniques in terms of ovarian reserve markers and ovarian residual volume have been performed (381)(382)(383)(384)(385)(386). Data from animal studies (387) and RCT (381,382,388) on the use of laser and plasma energy is encouraging and may result in less inadvertent tissue removal and thermal injury compared with cystectomy and bipolar electrosurgery.…”

Section: Fertility Sparing Surgerymentioning

confidence: 99%

Endometriosis-associated infertility: From pathophysiology to tailored treatment

Bonavina

Taylor

2022

Front. Endocrinol.

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Despite the clinically recognized association between endometriosis and infertility, the mechanisms implicated in endometriosis-associated infertility are not fully understood. Endometriosis is a multifactorial and systemic disease that has pleiotropic direct and indirect effects on reproduction. A complex interaction between endometriosis subtype, pain, inflammation, altered pelvic anatomy, adhesions, disrupted ovarian reserve/function, and compromised endometrial receptivity as well as systemic effects of the disease define endometriosis-associated infertility. The population of infertile women with endometriosis is heterogeneous, and diverse patients’ phenotypes can be observed in the clinical setting, thus making difficult to establish a precise diagnosis and a single mechanism of endometriosis related infertility. Moreover, clinical management of infertility associated with endometriosis can be challenging due to this heterogeneity. Innovative non-invasive diagnostic tools are on the horizon that may allow us to target the specific dysfunctional alteration in the reproduction process. Currently the treatment should be individualized according to the clinical situation and to the suspected level of impairment. Here we review the etiology of endometriosis related infertility as well as current treatment options, including the roles of surgery and assisted reproductive technologies.

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Section: Fertility Sparing Surgerymentioning

confidence: 99%

Endometriosis-associated infertility: From pathophysiology to tailored treatment

Bonavina

Taylor

2022

Front. Endocrinol.

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“…This finding suggests that the vasopressin injection procedure was more successful in preventing ovarian reserve damage. The main causes of the deterioration in ovarian reserve are thought to be the loss of healthy ovarian tissue and the destruction of ovarian tissue brought on using bipolar coagulation [9] . Several authors have suggested suturing just the ovary to prevent electrocoagulation damage [10,11] .…”

Section: Discussionmentioning

confidence: 99%

Comparison between Injection of Diluted Vasopressin and Saline Only in Laparoscopic Excision of Ovarian Endometrioma

Saber

Baiomy

2023

Evidence Based Women's Health Journal

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Introduction:The formation of tissue that resembles endometrium outside of the uterus is a hallmark of the chronic inflammatory disease known as endometriosis. Ovarian endometriosis typically affects women. 19%-28% of endometriosis patients have bilateral ovarian endometriomas. Laparoscopic cyst excision for endometriotic ovarian cysts improves fertility and reduces recurrence. The vasopressin injection approach was developed to reduce endometrioma recurrence and preserve ovarian reserve after laparoscopic cystectomy. Some texts and research recommend vasopressin for laparoscopic ovarian cystectomy. Material and Methods: This was a study done in Benha University hospital and Aminah Endoscopy Center from January 2021 to February 2022 . The study was conducted on 75 subjects. The study's subjects were women who were scheduled for laparoscopic surgery and had ovarian endometriomas. 25 patients are the group of non-injected laparoscopic cystectomy made up Group 1 (control group). 25 patients from Group 2 (the saline group) had saline injections and a laparoscopic cystectomy. Group 3 vasopressin injection group (VI group) included 25 patients who had laparoscopic cystectomy with diluted vasopressin injection. Results: In the VI and saline groups, there were statistically significant differences from the control group in the incidence of ovarian tissue involvement in endometrioma wall specimens, the thickness of tissue specimens, and the thickness of ovarian tissue accidentally removed. However, these alterations did not differ statistically significantly between the VIT and saline groups. Conclusion:Vasopressin injection method decreases the harm that conventional laparoscopic cystectomy causes to ovarian reserve.

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“…Several strategies have been reported to prevent ovarian reserve decline after laparoscopic ovarian surgery, including different surgical techniques, chemical agents, and medications [ 32 – 34 ]. Ovarian cystectomy reduced ovarian reserve after surgery more than ovarian ablation (or vaporization) and deroofing; however, cyst recurrence was found more often in patients treated with ovarian ablation and deroofing than cystectomy [ 26 , 35 ]. A systematic review involving 1047 patients demonstrated that laparoscopic ovarian suture preserved ovarian function more than bipolar electrosurgery did.…”

Section: Discussionmentioning

confidence: 99%

Effects of intravenous tranexamic acid on ovarian reserve and intra-operative blood loss during laparoscopic cystectomy of endometriotic cyst: a pilot randomized controlled trial

Akkaranurakkul

Lertvikool

Hongsakorn

et al. 2021

Pilot Feasibility Stud

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Background Strategies to preserve ovarian function after ovarian endometriotic cyst removal have been reported in many studies; however, no study has evaluated tranexamic acid administration during surgery. Objective To evaluate feasibility of conducting a definitive trial and assessing the potential efficacy of tranexamic acid on ovarian reserve and intra-operative blood loss by comparing mean differences in anti-Müllerian hormone (AMH) levels following laparoscopic ovarian cystectomy between tranexamic acid and control groups. Materials and methods A parallel two-arm pilot trial was conducted with 40 participants with endometriotic cysts who underwent laparoscopic ovarian cystectomy. They were randomized 1:1 to either 1 g tranexamic acid (TXA) or no TXA (n = 20 per group). TXA was administered to the participants immediately after induction of general anesthesia and intubation. The primary outcome was the feasibility of conducting a definitive trial in terms of design and procedures (such as recruitment rate, retention, safety of intravenous 1 gm of TXA, sample size verification) and assess the efficacy of TXA on the ovarian reserve and intra-operative blood loss by comparing mean difference of AMH levels between TXA and control groups at pre- and 3 months post-surgery. Results The recruitment and successful completion rates were 95% and 100%. Baseline characteristics were similar in the two groups. The mean difference of serum AMH levels (pre- and 3 months post-surgery) between the TXA and control groups was not significantly different. When performing a subgroup analysis, the mean difference of AMH levels (pre- and 3 months post-surgery) seemed to be higher in the bilateral than in the unilateral ovarian cyst group but not significantly different. Operating time was significantly longer in bilateral than in unilateral cysts. No post-operative complications or adverse effects were found. Conclusion The full randomized controlled trial for evaluating effects of TXA administration during laparoscopic cystectomy for endometrioma on ovarian reserve was shown to be feasible. Several modifications should be added for improving feasibility, for example, increasing the TXA dose, modifying TXA administration, focusing on either patients with unilateral or bilateral ovarian cysts, and exploring other outcome measures, e.g., surgeons’ satisfaction. Trial registration Thai Clinical Trials Registry, TCTR20190424002, Registered 24 April 2019.

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Ovarian Reserve Following Laparoscopic Ovarian Cystectomy vs Cyst Deroofing for Endometriomas

Cited by 13 publications

References 20 publications

Endometriosis-associated infertility: From pathophysiology to tailored treatment

Endometriosis-associated infertility: From pathophysiology to tailored treatment

Comparison between Injection of Diluted Vasopressin and Saline Only in Laparoscopic Excision of Ovarian Endometrioma

Effects of intravenous tranexamic acid on ovarian reserve and intra-operative blood loss during laparoscopic cystectomy of endometriotic cyst: a pilot randomized controlled trial

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