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

Abstract

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.