The effect of laparoscopic ovarian cystectomy versus coagulation in bilateral endometriomas on ovarian reserve as determined by antral follicle count and ovarian volume: a prospective randomized study

Var, Turgut; Batıoğlu, Sertaç; Tonguç, Esra; Kahyaoğlu, Serkan

doi:10.1016/j.fertnstert.2011.03.078

Cited by 92 publications

(79 citation statements)

References 35 publications

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“…11 Recent data suggested that excisional surgery of endometriomas, in particular the stripping technique may cause ovarian trauma. 10 Given the possible mechanism of cortical invagination leading to endometrioma formation, stripping of the cyst capsule may result in inadvertent removal of primordial, preantral and antral follicles from the healthy cortical tissue. This in turn may lead to iatrogenic depletion of ovarian follicles so ovarian reserve.…”

Section: Discussionmentioning

confidence: 99%

“…18 The loss of AFC associated with stripping of endometriomas may be clinically important in infertile patients, especially if they have low ovarian reserve so more careful attention is advised. 10 In the current study, we used the antral follicle count measured transvaginally …”

Section: Discussionmentioning

confidence: 99%

“…In a recent randomized study, Var et al compared the post-operative AFC, ovarian volume and response to ovulation stimulation in patients with bilateral endometriomas treated either by cystectomy or coagulation of cyst capsule with bipolar energy; they found that cystectomy was associated with more damage to the ovaries when assessed for these variables. 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.…”

Section: Fshmentioning

confidence: 99%

“…[7][8][9] Some literature suggested excisional surgery of endometriomas, in particular the stripping technique may cause ovarian trauma as loss of follicles and also loss of ovarian volume. 7,10 In contrast, Yeung et al reported advantages of laparoscopic excision of endometrioma by stripping of the cyst wall in terms of pain relief, less recurrence rate and high pregnancy rate. 6 We designed the present study to assess whether the laparoscopic cystectomy with stripping of ovarian endometrioma was effective on ovarian reserve as determined by ultrasonographic measurement of antral follicle count (AFC) and blood follicle stimulant hormon (FSH) level.…”

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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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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Fshmentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

The Effect of Unilateral Endometrioma Excision on Ovarian Reserve

Semiz¹,

Apı²,

Kayatas³

et al. 2015

Turkiye Klinikleri J Gynecol Obst

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“…W 2011 r. Var i wsp. przebadali 48 kobiet z obustronną endometriozą jajnika, aby ocenić wpływ dwóch różnych technik laparoskopowych na rezerwę jajnikową ocenianą na podstawie AFC oraz obję-tości jajnika [32]. Na podstawie tego badania z randomizacją wykazano, że zarówno wyłuszczenie torbieli, jak i koagulacja mają negatywny wpływ na rezerwę jajnikową, aczkolwiek metodą, która w większym stopniu prowadzi do uszkodzenia tkanki jajnika, jest wyłuszczenie pseudotorebki.…”

Section: -Badania Retrospektywne; Afc -Liczba Pęcherzyków Antralnych unclassified

Principles of removal of endometrial ovarian cysts with particular reference to ovarian reserve

Owczarek¹,

Malinowski²

2012

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StreszczenieEndometrioza, definiowana jako pozamaciczne występowanie komórek gruczołowych i podścieliska błony śluzowej macicy, nadal stanowi wielkie wyzwanie dla lekarzy ginekologów, zwłaszcza w zakresie płodności oraz dolegliwości bólowych. Częstym miejscem występowania endometriozy jest jajnik. Analizując ryzyko nawrotu torbieli, ryzyko nawrotu dolegliwości bólowych oraz współczynnik zajścia w ciążę, można uznać, że laparoskopia jest metodą z wyboru w leczeniu operacyjnym torbieli endometrialnych, wypierając tym samym klasyczną laparotomię. W wielu pracach zostały opisane różne techniki leczenia endoskopowego endometriozy jajnika, ale wydaje się, że standardem w leczeniu operacyjnym powinno być wyłuszczenie pseudotorebki. Każda operacja przeprowadzona z powodu torbieli endometrialnej pociąga za sobą ryzyko jatrogennego uszkodzenia jajnika, a tym samym -zmniejszenie rezerwy jajnikowej. Według danych klinicznych obecnie najlepszymi metodami oceny rezerwy jajnikowej są: liczba pęcherzyków antralnych (antral follicle count -AFC) oraz stężenie hormonu antymüllerowskiego (anti-müllerian hormone -AMH) w surowicy. Stężenie AMH silnie koreluje z AFC widocznych w badaniu ultrasonograficznym (USG). Mniejszą wartość diagnostyczną w ocenie rezerwy jajnikowej ma oznaczenie stężeń folikulotropiny (follicle-stimulating hormone -FSH), luteiny (luteinizing hormone -LH), estradiolu (E 2 ) oraz inhibiny w surowicy. Potrzeba dalszych badań oceniających wpływ energii elektrycznej i szycia jajnika jako metod uzyskania hemostazy na rezerwę jajnikową.Słowa kluczowe: endometrioza, torbiele, rezerwa jajnikowa. SummaryEndometriosis is defined as extra-uterine occurrence of endometrial glandular cells and endometrial stroma, and still represents a great challenge to gynecologists, especially in respect to fertility and pain. Endometriosis often occurs in ovaries. If you analyze the risk of cystic recurrence, the risk of pain recurrence and the pregnancy rate, you may consider that the laparoscopy is the method of choice in surgical treatment of endometrial cysts; correspondingly, it replaces the classical laparotomy. Many studies have described various techniques of endoscopic treatment of ovarian endometriosis, but it seems that the pseudocapsular enucleation should be the standard in surgical treatment. Every surgery carried out due to an endometrial cyst implies a risk of iatrogenic ovarian damage and, by the same token, a reduction in ovarian reserve. According to the newest clinical data, the best methods of assessing the ovarian reserve are: Antral Follicle Count (AFC) and serum concentration of Anti-Müllerian hormone (AMH). Concentration of AMH is highly correlated with the antral follicle count visible in the ultrasound examination. The evaluation of the serum concentration of FSH, LH, E2 and inhibin have a lower diagnostic value in the assessment of ovarian reserve. Further investigations are necessary to assess the impact of electric energy and of ovarian suture -as methods of achieving hemostasis -on the ovarian reserve.

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