{"paper_id":"02482315-33cc-432b-ae03-528069c4525d","body_text":"Algorithm of differentiated treatment of patients with ovarian endometrioma and infertility\nDOI:\nhttps://doi.org/10.15574/HW.2024.170.71Keywords:\nendometrioma, anti-mullerian hormone, antral follicle count, ovarian reserve, laparoscopy, sclerotherapy, platelet-rich plasmaAbstract\nPurpose - to improve fertility in women with ovarian endometrioma (ОЕ) and infertility using the proposed algorithm and treatment methods.\nMaterials and methods. The prospective study was conducted in 2 stages. In the first stage, 93 women with infertility were included in the study, who were divided into the following groups depending on the surgery performed: the Group 1 - with ОЕ sclerotherapy followed by platelet-rich plasma (PRP) injection into the ovarian tissue; the Group 2 - laparoscopic cystectomy followed by PRP injection into the ovarian tissue; the Control (C) group - with classical laparoscopic cystectomy.\nAfter dynamic observation, assessment of ovarian reserve and control of pregnancy for 12 months, an algorithm for differentiated treatment of ОЕ in women with infertility was developed. At the 2nd stage, 20 women (the Group 3) were treated with the proposed methods of treatment, such as sclerotherapy with ОЕ + PRP (the Subgroup 3a) and laparoscopic excision of the ОЕ + PRP capsule (the Subgroup 3b), based on the algorithm, and analyzed. Statistical processing of the results was performed using Microsoft Excel.\nResults. The mean level of anti-mullerian hormone (AMH) in the Subgroup 3a increased from 1.76 (CI: 1.47-1.71) ng/ml to 1.87 (CI: 1.63-1.86) ng/ml (p=0.036). In the Subgroup 3b, AMH changed from 2.15 (CI: 1.89-2.48) ng/ml to 2.22 (CI: 1.91-2.53) ng/ml (p>0.05). The number of antral follicles (AF) in the Subgroup 3a increased from 8.88 (CI: 7.90-9.90) to 11.10 (CI: 10.40-11.80) (p<0.001). In the Subgroup 3b, from 10.60 (CI: 9.90-11.20) to 11.00 (CI: 10.50-11.50) (p>0.05). Spontaneous pregnancy within 6 months occurred in 6 (60%) patients from the Subgroup 3a, and in 4 (40%) women from the Subgroup 3b (p>0.05). After 6 months of follow-up, 2 underwent assisted reproductive technology. The remaining women from the Subgroup 3a (3 (30%)) and the Subgroup 3b (5 (50%)) also had spontaneous pregnancies by 1 year of follow-up (p>0.05).\nConclusions. The proposed methods of treatment of ОЕ, sclerotherapy + PRP and laparoscopy + PRP, showed a significant positive effect on the preservation of ovarian reserve. A differential approach to the treatment of ОЕ based on the proposed algorithm increases the occurrence of spontaneous pregnancy.\nThe research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies.\nNo conflict of interests was declared by the authors.\nReferences\nAlborzi S, Sorouri ZZ, Askari E, Poordast T, Chamanara K. (2019). The success of various endometrioma treatments in infertility: A systematic review and meta-analysis of prospective studies. Reprod. Med. Biol. 18: 312-322. https://doi.org/10.1002/rmb2.12286; PMid:31607791 PMCid:PMC6780037\nBecker CM, Bokor A, Heikinheimo O, Horne A, Jansen F, Kiesel L, King K, Kvaskoff M, Nap A, Petersen K, Saridogan E, Tomassetti C, van Hanegem N, Vulliemoz N, Vermeulen N, ESHRE Endometriosis Guideline Group. (2022). ESHRE guideline: endometriosis. Human reproduction open. 2022(2). https://doi.org/10.1093/hropen/hoac009; PMid:35350465 PMCid:PMC8951218\nDaniilidis A, Grigoriadis G, Kalaitzopoulos DR, Angioni S, Kalkan Ü, Crestani A et al. (2023). Surgical Management of Ovarian Endometrioma: Impact on Ovarian Reserve Parameters and Reproductive Outcomes. J Clin Med. 12(16): 5324. https://doi.org/10.3390/jcm12165324; PMid:37629367 PMCid:PMC10455819\nExacoustos C, De Felice G, Pizzo A, Morosetti G, Lazzeri L, Centini G et al. (2018). Isolated Ovarian Endometrioma: A History Between Myth and Reality. J Minim Invasive Gynecol. 25(5): 884-891. https://doi.org/10.1016/j.jmig.2017.12.026; PMid:29353008\nKostrzewa M, Wilczyński JR, Głowacka E, Żyła M, Szyłło K, Stachowiak G. (2019). One-year follow-up of ovarian reserve by three methods in women after laparoscopic cystectomy for endometrioma and benign ovarian cysts. Int. J. Gynecol. Obstet. 146: 350-356. https://doi.org/10.1002/ijgo.12884; PMid:31197834\nLockyer EK, Schreurs A, Lier M, Dekker J, Melgers I, Mijatovic V. (2019). Treatment of ovarian endometriomas using plasma energy in endometriosis surgery: Effect on pelvic pain, return to work, pregnancy, and cyst recurrence. Facts Views Vis. Obgyn. 11(1): 49-55. PMID: 31695857; PMCID: PMC6822949.\nMuzii L, Galati G, Mattei G, Chinè A, Perniola G, Di Donato V et al. (2023). Expectant, Medical, and Surgical Management of Ovarian Endometriomas. Journal of Clinical Medicine. 12(5): 1858. https://doi.org/10.3390/jcm12051858; PMid:36902645 PMCid:PMC10003094\nDownloads\nPublished\nIssue\nSection\nLicense\nCopyright (c) 2024 Ukrainian Journal Health of Woman\nThis work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.\nThe policy of the Journal UKRAINIAN JOURNAL «HEALTH OF WOMAN» is compatible with the vast majority of funders' of open access and self-archiving policies. The journal provides immediate open access route being convinced that everyone – not only scientists - can benefit from research results, and publishes articles exclusively under open access distribution, with a Creative Commons Attribution-Noncommercial 4.0 international license (СС BY-NC).\nAuthors transfer the copyright to the Journal UKRAINIAN JOURNAL «HEALTH OF WOMAN» when the manuscript is accepted for publication. 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