The Impact of Excision of Ovarian Endometrioma on Ovarian Reserve: A Systematic Review and Meta-Analysis

Raffi, Francesca; Metwally, Mostafa; Amer, Saad

doi:10.1210/jc.2012-1558

Cited by 456 publications

(354 citation statements)

References 48 publications

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“…This hypothesis is further supported by the preliminary finding of an obvious trend towards a decline in AFC after LOD, although this did not reach statistical significance, possibly due to the small numbers involved in that analysis and high heterogeneity. Furthermore, we have recently reported a similar decline of circulating AMH after ovarian cystectomy (Raffi et al 2012, Mohamed et al 2016. This suggests that any surgical trauma to the ovary is associated with loss of ovarian follicles with subsequent reduction in AMH production.…”

Section: Discussionsupporting

confidence: 56%

“…The modified Newcastle-Ottawa scale was used for assessing the quality and risk of bias of the included studies (Raffi et al 2012, Mohamed et al 2016. Each article was scored according to three categories including selection (maximum three stars), comparability (four stars) and outcomes (two stars).…”

Section: Quality Of Included Studies and Risk Of Bias Assessmentmentioning

confidence: 99%

“…Outcome was scored according to completeness of at least 3-month follow-up after surgery. In the current analysis, we have given more weight to comparability factors and used the cut-off level of six stars with a minimum of three stars in the comparability category (Raffi et al 2012, Mohamed et al 2016. Table 1 shows the results of quality scores of the studies included in this analysis.…”

Section: Quality Of Included Studies and Risk Of Bias Assessmentmentioning

confidence: 99%

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The impact of laparoscopic ovarian drilling on AMH and ovarian reserve: a meta-analysis

Amer¹,

Shamy²,

James³

et al. 2017

Reproduction

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Laparoscopic ovarian drilling (LOD) has been widely used as an effective treatment of anovulatory women with polycystic ovarian syndrome (PCOS). However, there has been a growing concern over a possible damaging effect of this procedure on ovarian reserve. The objective of this study was to investigate the hypothesis that LOD compromises ovarian reserve as measured by post-operative changes in circulating anti-Müllerian hormone (AMH). This meta-analysis included all cohort studies as well as randomised controlled trials (RCTs) investigating serum AMH concentrations and other ovarian reserve markers in women with PCOS undergoing LOD. Various databases were searched including MEDLINE, EMBASE, Dynamed Plus, ScienceDirect, TRIP database, ClinicalTrials.gov and Cochrane Library from January 2000 to December 2016. Sixty studies were identified, of which seven were deemed eligible for this review. AMH data were extracted from each study and entered into the RevMan software to calculate the weighted mean difference (WMD) between pre-and post-operative values. Pooled analysis of all studies (n = 442) revealed a statistically significant decline in serum AMH concentration after LOD (WMD −2.13 ng/mL; 95% confidence interval (CI) −2.97 to −1.30). Subgroup analysis based on duration of follow-up, AMH kit, laterality of surgery and amount of energy applied during LOD consistently showed a statistically significant fall in serum AMH concentration. In conclusion, although LOD seems to markedly reduce circulating AMH, it remains uncertain whether this reflects a real damage to ovarian reserve or normalisation of the high pre-operative serum AMH levels. Further long-term studies on ovarian reserve after LOD are required to address this uncertainty.Reproduction (2017) 154 R13-R21

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Section: Discussionsupporting

confidence: 56%

Section: Quality Of Included Studies and Risk Of Bias Assessmentmentioning

confidence: 99%

Section: Quality Of Included Studies and Risk Of Bias Assessmentmentioning

confidence: 99%

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The impact of laparoscopic ovarian drilling on AMH and ovarian reserve: a meta-analysis

Amer¹,

Shamy²,

James³

et al. 2017

Reproduction

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“…However, concerns have been raised recently as for the detrimental effects of excision on ovarian function. Along with the emerging role of serum anti-Müllrerian hormone (AMH) level as a marker for the quantitative aspect of ovarian function [8], the expanding body of literature has been reporting a negative quantitative effect of excision with lower AMH levels after surgery [9,10]. Although AMH levels are easy to measure, the reliability of AMH measured by current methods as a marker of ovarian reserve has been questioned by some authors [11,12].…”

Section: Introductionmentioning

confidence: 99%

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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“…Since the ovarian endometrioma is a pseudocyst, excisional surgery involves the removal of ovarian cortex with primordial follicles, reducing the fertility potential of the affected ovary, especially when extensive hemostasis irreversibly diminishes or impairs the blood supply towards the affected ovary. Ovarian cystectomy for endometriomas seems to cause significant damage to ovarian reserve with up to 40 % fall in serum AMH concentration [5,6]. According to Donnez et al, cystectomy may be destructive for the ovary, whereas ablation may be incomplete with a greater risk of recurrence [7].…”

Section: Introductionmentioning

confidence: 99%

Efficacy of ovarian suspension to round ligament with a resorbable suture to prevent postoperative adhesions in women with ovarian endometrioma: follow-up by transvaginal hydrolaparoscopy

et al. 2014

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The aim of this study was to assess the effect of ovarian suspension to the round ipsilateral ligament with a resorbable suture, performed during laparoscopic surgery for endometrioma, on postoperative ovarian adhesion formation. The tool used to assess this effect was not conventional laparoscopy but outpatient transvaginal hydrolaparoscopy. Fifty women with single ovarian endometrioma were divided in two groups (group A, 24 and group B, 26). All patients underwent laparoscopic ovarian cystectomy for endometriosis. In group A, the ovary was suspended to the ipsilateral round ligament. In group B, ovarian suspension was not performed. All patients underwent transvaginal outpatient hydrolaparoscopy as follow-up. A significantly lower rate of postsurgical ovarian adhesion in group A in comparison with group B (33.3 vs 80.8 %-p=0.001) was observed. Operative time and postoperative pain were similar in both groups. Ovarian suspension to the ipsilateral round ligament with a resorbable suture during surgery for endometrioma is associated with a lower rate of postoperative ovarian adhesion formation.

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The Impact of Excision of Ovarian Endometrioma on Ovarian Reserve: A Systematic Review and Meta-Analysis

Abstract: The results of this study suggest a negative impact of excision of endometriomas on ovarian reserve as evidenced by a significant postoperative fall in circulating AMH.

Cited by 456 publications

References 48 publications

The impact of laparoscopic ovarian drilling on AMH and ovarian reserve: a meta-analysis

The impact of laparoscopic ovarian drilling on AMH and ovarian reserve: a meta-analysis

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

Efficacy of ovarian suspension to round ligament with a resorbable suture to prevent postoperative adhesions in women with ovarian endometrioma: follow-up by transvaginal hydrolaparoscopy

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