{"paper_id":"0b5d911b-3b63-41d5-8491-490cc78f93b2","body_text":"Abstract\nOvarian endometriomas (OEs) are a frequent clinical manifestation of endometriosis. It is controversial how OE may affect women’s fertility, and it is an important consideration when planning treatment in women who want to retain the potential of future childbearing. This chapter will describe the association between OEs and diminished ovarian reserve, with a particular focus on spontaneous ovulation rates, markers of ovarian reserve, and response to ovarian stimulation. Based on current evidence, although there are plausible biological effects on the ovarian cortex surrounding OE and an impairment of the normal ovarian physiology, the impact of OE per se is not significant. There is a negligible detrimental effect on ovarian reserve with spontaneous ovulation not being impaired. Surgical removal of OE may worsen ovarian function by removing healthy ovarian cortex or compromising blood flow to the ovary. It is evident that surgical excision of OE acutely impairs ovarian function as measured by ovarian reserve markers. Additionally, a reduced response of the ovaries to gonadotrophins has been described after surgical removal of OE. Whether the decrease of ovarian function represents progressive or long-term impairment remains the subject of ongoing investigation.\nAccess this chapter\nTax calculation will be finalised at checkout\nPurchases are for personal use only\nSimilar content being viewed by others\nReferences\nBusacca M, Vignali M. Ovarian endometriosis: from pathogenesis to surgical treatment. Curr Opin Obstet Gynecol. 2003;15:321–6.\nBrosens IA, Puttemans PJ, Deprest J. The endoscopic localization of endometrial implants in the ovarian chocolate cyst. Fertil Steril. 1994;61:1034–8.\nJadoul P, Kitajima M, Donnez O, Squifflet J, Donnez J. Surgical treatment of ovarian endometriomas: state of the art? Fertil Steril. 2012;98:556–63.\nRuiz-Flores FJ, Garcia -Velasco JA. Is there a benefit for surgery in endometrioma-associated infertility? Curr Opin Obstet Gynecol. 2012;24:136–40.\nShah DK, Mejia RB, Levobic DI. Effect of surgery for endometrioma on ovarian function. J Minim Invasive Gynecol. 2014;21:203–9.\nAta B, Uncu G. Impact of endometriomas and their removal on ovarian reserve. Curr Opin Obstet Gynecol. 2015;27:235–41.\nSánchez AM, Viganò P, Somigliana E, Panina-Bordignon P, Vercellini P, Candiani M. The distinguishing cellular and molecular features of the endometriotic ovarian cyst: from pathophysiology to the potential endometrioma-mediated damage to the ovary. Hum Reprod Update. 2014;20:217–30.\nKitajima M, Defrère S, Dolmans MM, Colette S, Squifflet J, Van Langendonckt A, Donnez J. Endometriomas as a possible cause of reduced ovarian reserve in women with endometriosis. Fertil Steril. 2011;96:685–91.\nKitajima M, Dolmans MM, Donnez O, Masuzaki H, Soares M, Donnez J. Enhanced follicular recruitment and atresia in cortex derived from ovaries with endometriomas. Fertil Steril. 2014;101:1031–7.\nHorikawa T, Nakagawa K, Ohgi S, Kojima R, Nakashima A, Ito M, Takahashi Y, Saito H. The frequency of ovulation from the affected ovary decreases following laparoscopic cystectomy in infertile women with unilateral endometrioma during a natural cycle. J Assist Reprod Genet. 2008;25:239–44.\nBenaglia L, Somigliana E, Vercellini P, Abbiati A, Ragni G, Fedele L. Endometriotic ovarian cysts negatively affect the rate of spontaneous ovulation. Hum Reprod. 2009;24:2183–6.\nLeone Roberti Maggiore U, Scala C, Venturini PL, Remorgida V, Ferrero S. Endometriotic ovarian cysts do not negatively affect the rate of spontaneous ovulation. Hum Reprod. 2015;30:299–307.\nKitajima M, Khan KN, Hiraki K, Inoue T, Fujishita A, Masuzaki H. Changes in serum anti-Müllerian hormone levels may predict damage to residual normal ovarian tissue after laparoscopic surgery for women with ovarian endometrioma. Fertil Steril. 2011;95:2589–91.\nStreuli I, de Ziegler D, Gayet V, Santulli P, Bijaoui G, de Mouzon J, Chapron C. In women with endometriosis anti-Müllerian hormone levels are decreased only in those with previous endometrioma surgery. Hum Reprod. 2012;27:3294–303.\nKim JY, Jee BC, Suh CS, Kim SH. Preoperative serum anti-mullerian hormone level in women with ovarian endometrioma and mature cystic teratoma. Yonsei Med J. 2013;54:921–6.\nVercellini P. Serum anti-mullerian hormone in reproductive aged women with benign ovarian cysts. Eur J Obstet Gynecol Reprod Biol. 2014;180:142–7.\nAta B. Prospective assessment of the impact of endometriomas and their removal on ovarian reserve and determinants of the rate of decline in ovarian reserve. Hum Reprod. 2013;28:2140–5.\nSomigliana E, Benaglia L, Paffoni A, Busnelli A, Vigano P, Vercellini P. Risks of conservative management in women with ovarian endometriomas undergoing IVF. Hum Reprod Update. 2015;21:486–99.\nGarcia-Velasco JA. In vitro fertilization outcome in women with unoperated bilateral endometriomas. Fertil Steril. 2013;99:1714–9.\nGarcia-Velasco JA, Somigliana E. Management of endometriomas in women requiring IVF: to touch or not to touch. Hum Reprod. 2009;24:496–501.\nLi CZ, Liu B, Wen ZQ, Sun Q. The impact of electrocoagulation on ovarian reserve after laparoscopic excision of ovarian cysts: a prospective clinical study of 191 patients. Fertil Steril. 2009;92:1428–35.\nRoman H Auber M, Mokdad C, Martin C, Diguet A, Marpeau L, Bourdel N. Ovarian endometrioma ablation using plasma energy versus cystectomy: a step toward better preservation of the ovarian parenchyma in women wishing to conceive. Fertil Steril. 2011;96:1396–400.\nDonnez J, Lousse JC, Jadoul P, Donnez O, Squifflet J. Laparoscopic management of endometriomas using a combined technique of excisional (cystectomy) and ablative surgery. Fertil Steril. 2010;94:28–32.\nTsolakidis D, Pados G, Vavilis D, Athanatos D, Tsalikis T, Giannakou A, Tarlatzis BC. The impact on ovarian reserve after laparoscopic ovarian cystectomy versus three-stage management in patients with endometriomas: a prospective randomized study. Fertil Steril. 2010;94:71–7.\nRaffi F, Metwally M, Amer S. The impact of excision of ovarian endometrioma on ovarian reserve: a systematic review and meta-analysis. J Clin Endocrinol Metab. 2012;97:3146–54.\nSomigliana E, Berlanda N, Benaglia L, Viganò P, Vercellini P, Fedele L. Surgical excision of endometriomas and ovarian reserve: a systematic review on serum antimullerian hormone level modifications. Fertil Steril. 2012;98:1531–8.\nUncu G Kasapoglu I, Ozerkan K, Seyhan A, Oral Yilmaztepe A, Ata B. Prospective assessment of the impact of endometriomas and their removal on ovarian reserve and determinants of the rate of decline in ovarian reserve. Hum Reprod. 2013;28:2140–5.\nUrman B, Alper E, Yakin K, et al. Removal of unilateral endometriomas is associated with immediate and sustained reduction in ovarian reserve. Reprod Biomed Online. 2013;27:212–6.\nAlborzi S, Keramati P, Younesi M, Samsami A, Dadras N. The impact of laparoscopic cystectomy on ovarian reserve in patients with unilateral and bilateral endometriomas. Fertil Steril. 2014;101:427–34.\nAta B, Tukgeldi E, Seyhan A, Urman B. Effect on hemostatic method on ovarian reserve following laparoscopic endometrioma excision; comparison of suture, hemostatic sealant and bipolar dessication: a systematic review and meta-analysis. J Minim Invasive Gynecol. 2015;22:363–72.\nSong T, Kim WY, Lee KW, Kim HH. Effect on ovarian reserve on hemostasis by bipolar coagulation versus suture during laparoendoscopic single-site cystectomy for ovarian endometriomas. J Minim Invasive Gynecol. 2015;22:415–20.\nMuzii L, Di Tucci C, Di Feliciantonio M, Marchetti C, Perniola G, Panici PB. The effect of surgery for endometrioma on ovarian reserve evaluated by antral follicle count: a systematic review and meta-analysis. Hum Reprod. 2014;29:2190–8.\nMuzii L, Bianchi A, Croce C, Manci N, Panici PB. Laparoscopic excision of ovarian cysts: is the stripping technique a tissue-sparing procedure? Fertil Steril. 2002;77:609–14.\nVercellini P, Chapron C, De Giorgi O, Consonni D, Frontino G, Crosignani PG. Coagulation or excision of ovarian endometriomas? Am J Obstet Gynecol. 2003;188:606–10.\nCheong Y. The impact of endometrioma on IVF/ICSI outcomes: a systematic review and meta-analysis. Hum Reprod Update. 2015;21:809–25.\nMicucci G. Is operative laparoscopy safe in ovarian endometriosis? Reprod Biomed Online. 2009;18:167.\nScarselli G. Ovarian surgery for bilateral endometriomas influences age at menopause. Hum Reprod. 2011;26:3000–7.\nRagni G. IVF-ICSI outcome in women operated on for bilateral endometriomas. Hum Reprod. 2008;23:1526–30.\nVercellini P. Fertility preservation in women with endometriosis: for all, for some, for none? Hum Reprod. 2015;30:1280–6.\nAuthor information\nAuthors and Affiliations\nCorresponding author\nEditor information\nEditors and Affiliations\nRights and permissions\nCopyright information\n© 2018 Springer International Publishing AG, part of Springer Nature\nAbout this chapter\nCite this chapter\nMartínez-Zamora, MA., Casals, G., Peralta, S., Carmona, F. (2018). Endometrioma and Ovarian Reserve: A Surgical Approach. In: Gomes-da-Silveira, G.G., da Silveira, G.P.G., Pessini, S.A. (eds) Minimally Invasive Gynecology. Springer, Cham. https://doi.org/10.1007/978-3-319-72592-5_10\nDownload citation\nDOI: https://doi.org/10.1007/978-3-319-72592-5_10\nPublished:\nPublisher Name: Springer, Cham\nPrint ISBN: 978-3-319-72591-8\nOnline ISBN: 978-3-319-72592-5\neBook Packages: MedicineMedicine (R0)","source_license":"CC0","license_restricted":false}