Ovarian reserve in patients who have undergone endometriosis surgery

Olivera Džatić Smiljković; Mladenko  Vasiljević; Ivana  Rudić; Jelena  Vugdelić; Aleksandar  Ristić; Rada  Vugdelić

doi:10.2298/VSP160408363D

Olivera Džatić Smiljković Medical Faculty University of Belgrade University Clinic of Gynecology and Obstetrics “Narodni Front”, Belgrade, Serbia
Mladenko Vasiljević University of Belgrade, Faculty of Medicine, University Clinic of Gynecology and Obstetrics “Narodni Front”, Belgrade, Serbia
Ivana Rudić University of Belgrade, Faculty of Medicine, University Clinic of Gynecology and Obstetrics “Narodni Front”, Belgrade, Serbia
Jelena Vugdelić University of Belgrade, Faculty of Medicine, University Clinic of Gynecology and Obstetrics “Narodni Front”, Belgrade, Serbia
Aleksandar Ristić University of Belgrade, Faculty of Medicine, University Clinic of Gynecology and Obstetrics “Narodni Front”, Belgrade, Serbia
Rada Vugdelić University of Belgrade, Faculty of Medicine, University Clinic of Gynecology and Obstetrics “Narodni Front”, Belgrade, Serbia

DOI: https://doi.org/10.2298/VSP160408363D

Keywords: endometriosis;, infertility; laparoscopy;, cystectomy;, cystotomy;, treatment outcome.

Abstract

Background/Aim. Endometriosis is a gynaecological disorder characterized by the presence of endometrial tissue outside the uterine cavity. The aim of this paper was to determine the effect of laparoscopic cystotomy and cystectomy on ovarian function, as well as to compare these two methods in terms of qualitative and quantitative damage to the ovaries, achieved pregnancies and recurrence. Methods. The prospective study, conducted in “Narodni Front” Obstetrics and Gynaecology Clinic in Belgrade at the Endoscopic Infertility Treatment Ward, included a total of 150 patients. The study group was represented by 100 patients who underwent a surgical treatment of endometrial ovarian cysts. The patients in the study group were divided into 2 subgroups: Subgroup I consisted of 50 patients who underwent a laparoscopic cystotomy (incision of the cyst and thermal coagulation) and subgroup II which included 50 women who underwent a laparoscopic cystectomy. The control group consised of patients who underwent a surgery due to tubal factor infertility. The following parameters of the ovarian function were tested: the ovarian volume, the antral follicle count, the presence of the preovulatory follicle on the operated ovary, the serum levels of anti-Müllerian hormone (AMH), follicle-stimulating hormone (FSH), ovarian tumor marker (Ca 125), inhibin B, as well as the rate of achieved pregnancies one year after the surgery. Results. The ovarian volume and the antral follicle count as well as the FSH values were significantly higher in the control group in comparison with the patients in the study group. There were no significant differences in the ovarian volume, the antral follicle count, the AMH values and inhibin B values in the study group between the patients with cystectomy and those with the incision and coagulation of the cyst. Conclusion. Both surgical techniques diminished the ovarian reserve: cystectomy was more aggressive method in terms of the damage inflicted on the ovarian tissue, and incision with coagulation carried a higher risk of recurrence.

Author Biography

Olivera Džatić Smiljković, Medical Faculty University of Belgrade University Clinic of Gynecology and Obstetrics “Narodni Front”, Belgrade, Serbia

Head of ultrasound department

References

REFERENCES:

Ulukus M, Cakmak H, Arici A. The role of endometrium in endometriosis. J Soc Gynecol Investig 2006; 13(7): 467‒76.

Waller KG, Lindsay P, Curtis P, Shaw RW. The prevalence of endometriosis in women with infertile partners. Eur J Obstet Gynecol Reprod Biol 1993; 48(2): 135‒9.

Haney AF. Endometriosis: Pathogenesis and pathophysiol¬ogy. In: Wilson EA, editor. Endometriosis. New York: AR Liss; 1987. p. 23‒51.

Nezhat F, Nezhat C, Allan CJ, Metzger DA, Sears DL. Clini¬cal and histologic classification of endometriomas. Implica¬tions for a mechanism of pathogenesis. J Reprod Med 1992; 37(9): 771‒6. PubMed PMID: 1453396

Cahill DJ, Hull MG. Pituitary-ovarian dysfunction and en-dometriosis. Hum Reprod Update 2000; 6(1): 56‒66.

Goswamy RK, Campbell S, Royston JP, Bhan V, Battersby RH, Hall VJ, et al. Ovarian size in postmenopausal women. Br J Obstet Gynecol 1988; 95(8): 795‒801.

Ng EH, Yeung WS, Fong DY, Ho PC. Effects of age on hor-monal and ultrasound markers of ovarian reserve in Chi¬nese women with proven fertility. Hum Reprod 2003; 18(10): 2169‒74.

Marton U. Significance of three-dimensional ultrasound and three-dimensional colod Doppler in evaluation of in vitro fer-tilisation outcome [dissertation]. Zagreb: Facultz of Medicine; 2005. (Croatian)

Hendriks DJ, Mol BW, Bansci LF, te Velde ER, Broekmans FJ. Antral follicle count in the prediction of poor ovarian response and pregnancy after in vitro fertilization: A meta-analysis after comparison with basal FSH level. Fertil Steril 2005; 83(2): 291‒301.

Salihoğlu KN, Dilbaz B, Cırık DA, Ozelci R, Ozkaya E, Mol-lamahmutoğlu L. Short-Term Impact of Laparoscopic Cys-tectomy on Ovarian Reserve Tests in Bilateral and Unilat¬eral Endometriotic and Nonendometriotic Cysts. J Minim Invasive Gynecol 2016; 23(5): 719‒25.

Candiani M, Barbieri M, Bottani B, Bertulessi C, Vignali M, Agnoli B, et al. Ovarian recovery after laparoscopic enucle-ation of ovarian cysts: Insights from echographic short-term postsurgical follow-up. J Min Invasive Gynecol 2005; 12(5): 409‒14.

Somigliana E, Ragni G, Benedetti F, Borroni R, Vegetti W, Crosignani PG. Does laparoscopic exision of ovarian cysts significantly affect ovarian reserve? Insights from IVF. Hum Reprod 2003; 18(11): 2450‒3.

Zhang CH, Wu L, Li PQ. Clinical study of the impact on ova-rian reserve by different hemostasis methods in laparo¬scopic cystectomy for ovarian endometrioma. Taiwan J Obstet Gyne-col 2016; 55(4): 507‒11.

Beretta P, Franchi M, Ghezzi F, Busacca M, Zupi E, Bolis P. Ran-domised clinical trial of two laparoscopic treatments of endo-metriomas: Cystectomy versus drainage and coagula¬tion. Fertil Steril 1998; 70(6): 1176‒80.

Ragni G, Somigliana E, Benedetti F, Paffoni A, Vegetti W, Resteli L, et al. Demage to ovarian reserve associated with laparoscopic excision of endometriomas: A quantitative rather than a qualitative injury. Am J Obstet Gynecol 2005; 193(6): 1908‒14.

Hock DL, Sharafi K, Dagostino L, Kemmann E, Seifer DB. Contribution of diminished ovarian reserve to hypofertil¬ity associated with endometriosis. J Reprod Med 2001; 46(1): 7‒10.

Frankurt S, Nunes AL, Reis AD, Crostofolini DM, Bianco B, Barbosa CP. Evaluation of basal FSH, serum levels in infer¬tile patients with deep ovarian endometriosis who under¬went sur-gery. Rev Bras Ginecol Obstet 2009; 31(7): 349‒52. (Portu-guesse)

Lemos NA, Arbo E, Scalco R, Weiler E, Rosa V, Cunha-Filho JS. Decreased anti-Mullerian hormone and altered ovarian follicu-lar cohort in infertile patients mild/minimal endo¬metriosis. Fertil Steril 2008; 89(5): 1064‒8.

Cheng YM, Wang ST, Chou CY. Serum CA-125 in preopera¬tive patients at high risk for endometriosis. Ob¬stet Gynecol 2002; 99(3): 375‒80.

Ruan YQ, Liang WG, Huang SH. Analysis of laparoscopy on endometriosis patients with high expression of CA125. Eur Rev Med Pharmacol Sci 2015; 19(8): 1334‒7.

Sutton CJG, Nair S, Ewen SP, Haines P. A comparison be¬tween the CO2 and KTP lasers in the treatment of large ovarian endometriomas. Gynecol Endoscopy 1993; 2: 113‒6.

Muzii L, Luciano A, Zupi E, Panici PB. Effect of Surgery for Endometrioma on Ovarian Function: A Different Point of View. J Minim Invasive Gynecol 2016; 21(4): 531‒3.

Hemmings R, Bissonnette F, Bouzayen R. Results of laparo¬scopic treatments of ovarian endometriomas: Laparoscopic ovarian fenestration and coagulation. Fertil Steril 1998; 70(3): 527‒9.

Alborzi S, Momtahan M, Parsanezhad ME, Dehbashi S, Zol¬shardi J, Alborzi S. A prospective, randomized study com¬paring lapa-roscopic ovarian cystectomy versus fenestration and coagula-tion in patients with endometriomas. Fertil Steril 2004; 82(6): 1633‒7.