{"paper_id":"7dbebffe-f3bb-44ce-8a85-2eaa012cf6da","body_text":"Mini Review\nVolume 1 Issue 1 - May  2017\nDOI: 10.19080/GJORM.2017.01.555564\nGlob J Reprod Med\nCopyright © All rights are reserved by Vasilios Tanos\nThe Effect of Hemostatic Method on Ovarian \nReserve following Endometrioma Excision\nVasilios Tanos1* and Sayed El Akhras2\n1Medical School, Nicosia University, Egypt\n2Director of the Department of Gynecology, Omam Hospital, Egypt\nSubmission:  May 15, 2017; Published: May 30, 2017\n*Corresponding author: Vasilios Tanos, Medical School, Nicosia University, Cyprus, Tel: ; Fax: +35799512371; \n Email: \nBackground\nFigure 1: The generation of an ovarian endometrioma as observed in Trans Vaginal Hydrolaparoscopy confirming Sampson hypothesis \nfor pathogenesis.\na. Implantation of regurgitated endometrial cells during menses via tube on ovarian surface\nb. Persistent inflammation Neoangiogenesis, lesion spreading Bleeding at implantation site \nc. Chronic inflammation causes adhesions, cortex invagination and endometrioma formation\nGlob J Reprod Med 1(3): GJORM.MS.ID.555564 (2017)  0068\nAbstract\nEndometrioma surgery and hemostasis negative affect ovarian reserve. The size of the endometrioma and the surgical technique are the \nmost determining factors preserving ovarian function. Stripping the endometrioma pseudocapsule is detrimental for healthy ovarian tissue, \nreduces the risk of recurrence, however, not appropriate for infertility patients undergoing ART . Fenestration and laser vaporization of an \nendometrioma seems to minimally destruct the healthy ovarian tissue, offering the best surgical treatment option to infertility patients.\nKeywords: Cystectomy; Endometrioma; Hemostasis; Ovarian reserve; Antral follicle count \nAbbreviations: AFC: Antral Follicle Count; AMH  : Anti-Mullerian Hormone; ART: Assisted Reproductive Technology; DGGG: Deutsche \nGesellschaftfürGynäkologie und Geburtshilfe eV (The German Society for Gynecology and Obstetrics eV); E2: Estradiol; FSH: Follicle-\nStimulating Hormone; IVF: In Vitro  Fertilization; LH: Luteinizing Hormone; MOD: Mean Ovarian Diameter; PRCTs: Prospective Randomized \nClinical Trial; RCTs: Randomized Clinical Trial\n\n\nHow to cite this article: Tanos V, El Akhras S. The Effect of Hemostatic Method on Ovarian Reserve following Endometrioma Excision. Glob J Reprod \nMed. 2017; 1(3): 555564. DOI: 10.19080/GJORM.2017.01.5555640069\nGlobal Journal of Reproductive Medicine\nFigure 2: Treatment of a 2cm ovarian endometrioma by Trans Vaginal Hydro-laparoscopy at a very early stage confirms the development \nof pseudocapsule which is actually the ovarian cortex.\na .2cm endom/oma ablation using THVL bipolar energy\nb. Endometrioma pseudocapsule \nc. After endometrioma excision and ablation, completely cures ovarian epithelium, and reappears normal with pinkish color\nEndometrioma develops from the ovarian epithelium, hence \naffects in general ovarian function but especially folliculogenesis \n[1]. Decreased antral follicle count (AFC) and reduction in the \nnumber of oocytes retrieved during IVF have been repeatedly  \nreported [2-5]. Ovarian endometriosis is often a marker for \nmore extensive pelvic and intestinal disease [6] Trans-vaginal \nhydrolaproscopy elucidates the pathogenesis and can provide \nthe treatment of small ovarian endometrioma upto 3cm [1]. \nImplantation of regurgitated endometrial cells via tubal lumen \nduring menses on ovarian surface causes persistent inflammation, \nbleeding at implantation site and invagination of the ovarian \ncortex, adhesions, cystic formation, tissue alterations and \ndeformity (Figure 1) hence, the endometrioma pseudocapsule \nis actually the ovarian epithelium with the follicular structures \nand oocytes. Once an endometrioma is open after thorough \nirrigation, careful endoscopic close up image reveals scanty \nareas of pinkish tissue which is actually the ovarian epithelium. \nOf course the majority of the exposed tissue is embedded with \nendometriotic cells that will be destroyed, usually by an effort of \nstripping the capsule or bipolar coagulation, laser etc. \nAmong patients with endometriosis 17-44% have \nendometriomas [7-9], whereas more frequently located on the  \n \nleft ovary [10,11] Medical treatments lead only to a temporary \nvolume reduction [12] while drainage leads to a quick recurrence \nand increases the risk of abscess [13] Surgery is the only way \nto treat endometrioma (DGGG). Extensive endometrioma \nsurgery by stripping or ablation of the pseudocapsule offers low \nrecurrence rate however, healthy ovarian tissue is destroyed \nwhich is vital for patients under fertility treatment [14]. When \nno stripping is performed and electrocoagulation is applied with \ncaution the recurrence rate can be 9.6-45% [15] It is also quite \ndebatable whether cytoreductive methods like laser, plasma \nand bipolar energies and suturing are all equally detrimental to \nhealthy ovarian tissue found below an endometrioma.\nIn this article we review the impact of endometrioma surgery \nand haemostasis technique on the ovarian reserves. Pub Med \nliterature review for facts, views and news about endometrioma \nsurgical technique and hemostatic method preserving ovarian \nhealthy tissue and reserves was performed. Ovarian reserves \nare compromised during endometrioma surgery; many \nprospective cohort studies have shown the detrimental action \nof endometrioma excision by stripping technique and diathermy \nas haemostatic method on ovarian reserves. Uncu et al. [16] \ncompared the AMH and AFC results before and after surgery \nin 30 patients with endometrioma and 30 patients with simple \novarian cysts. There was a significant reduction in both markers \nin endometrioma group. Another prospective study by Chen et \nal. [17] compared 40 patients with endometrioma to 22 patients \nwith benign ovarian cysts and 38 infertility patients with tubal \ninfertility. The AMH was significantly reduced in endometioma \nexcision cases while in the other 2 groups results were similar \nand not affected by surgery AMH measured in ng/ml fluctuated \nto 1.53±1.37 in endometrioma cases, 2.20±1.23 in benign cysts \nand 2.82±1.74 in patients with tubal factor.\nMarkers of ovarian reserve\nThe Anti mullerian Hormone (AMH), FSH, LH, E2 levels and \nInhibin as biomarkers, the antral follicular count (AFC), ovarian \n\nHow to cite this article: Tanos V, El Akhras S. The Effect of Hemostatic Method on Ovarian Reserve following Endometrioma Excision. Glob J Reprod \nMed. 2017; 1(3): 555564. DOI: 10.19080/GJORM.2017.01.5555640070\nGlobal Journal of Reproductive Medicine\nvolume and diameter as sonographic markers have all been \nreported as indicators for ovarian reserves. A comparative AMH \nlevel and AFC of low fertility potential usually referred to “poor \nresponders” which according to Bologna criteria are defined \nwhen AMH is 0.5-1.1ng/ml and AFC 5-7 follicles [18] An AMH of \n2ng/ml is considered as abnormal in women aged <30 years old \n[19] indicating the decreased overall number of oocytes but not \nthe ability of an ovum to reach fertilization and pregnancy.\nAmong all biological and clinical markers for ovarian reserves \nAMH and AFC are considered the most reliable measurements. \nAMH has similar correlation with primordial follicle count and \nsimilar capacity for predicting ovarian response to stimulation \n[20-22] Inter-cycle and intra-individual variation of AMH is \nsignificantly less than that of AFC in several studies [23] AFC is \nless reliable than AMH because antral follicles may be obscured \nby an endometrioma leading to underestimation of AFC pre and \npost operatively, however AMH samples are stable at -70 °C to \n-80 °C which makes storage difficult while most of the studies do \nnot report the AMH specimens handling process [24]. \nA letter to the Editor in 2014 in the journal of Human \nReproduction about meta-analysis weakness [25] 1/8 studies by \nRaffi et al. reported storing samples at -20 °C while samples were \neither analyzed directly without cryostorage [26,27] or were \nstored at -70 or -80 °C before actual measurements in the remain 5 \nstudies [28-31] In addition, the impact of surgery type on ovarian \nreserves involves several biases such as the age of the patients, \npersistence, size, location and bilaterality of the endometrioma. \nConcomitant pathologies like adhesions, endometriosis, tubal \nand fossa ovarica status, training and experience of surgeon, \ntype of surgery technique used (biopsy, stripping, excision) and \ntype of haemostasis used (Bipolar, Suturing, Laser, Sealants) all \nare variables that can influence AMH results. \nAMH levels after endometrioma excision\nSignificant decline in serum AMH levels 1-3 months after \nendometrioma excision [32]. Progressive decline in AMH levels in \ntwo studies during 6 months after excision and [33,34] persistent \ndecline in AMH during and after 6 months after endometrioma \nexcision have been reported [24,25] Bilateral excision causes \na greater decline in serum AMH levels than unilateral [16,29] \nSecond surgery for recurrent unilateral endometrioma causes \neven lower AMH levels and AFC of the affected ovary than \nbefore surgery as reported by [11] However, the number of \novarian follicles on surgical specimens did not correlate with the \ndecline in serum AMH levels [16,29,33] Damage to the ovarian \ncirculation could be the most important determinant of the loss \nof ovarian reserve, Especially bipolar dissection near the ovarian \nhilus.\nThe selection of haemostatic method is crucial for ovarian \nreserves Statistical comparison between post-operative mean \nvalues of AFC (antral follicular count) PSV (Peak Systolic Velocity) \nand MOD (Mean ovarian diameter) on TVS examinations \ncomparing long term impact on ovarian reserve between \nlaparoscopic ovarian cystectomy and bipolar coagulation and \nopen laparotomy and suturing for ovarian endometrioma, \ndemonstrated significantly better ovarian reserves in favour \nto laparotomy group. It was noted that the damage, cannot be \nascribed only to the amount of ovarian tissue removed during \nsurgery but also to the possible damage of the ovarian vascular \nsystem by electrocoagulation [35]. \nThe impact of electrocoagulation on ovarian reserve was \ninvestigated in 191 patients by a prospective randomized \nstudy, Group 1 underwent laparoscopic ovarian cystectomy by \ncoagulation or harmonic scalpel and a second group of patients \noperated by laparotomy and suturing of the cyst bed. After \n12 months of follow up In electrocoagulation group, FSH was \nover 10 IU/L and AFC and mean ovarian diameter(MOD) were \nsignificantly reduced [36]. Comparing ovarian reserve after \nlaparoscopic excision of endometrioma cysts and hemostasis \nachieved either by bipolar coagulation or suturing a randomized \nclinical trial by Asgari Z, et al. [37] concluded that stripping \nof endometrioma pseudo-capsule reduces ovarian reserve, \nregardless of the hemostatic methods used. Intracorporeal \nsuturing showed less damage on ovarian reserve as compared to \nbipolar electrocoagulation. \nMinimal invasive surgery of 67 endometrioma and 62 non \nendometrioma ovarian cysts, the AMH in 43 patients treated \nwith bipolar drop by 41.2% while in 86 patients haemostasis \nachieved with sealants drop by 15.4% (P= 0.003) [38].\nIn 10 ovarian endometriomas of >30mm, managed by \ncomplete vaporization of the inner surface using plasma energy \nfollowed by cystectomy. Histologic evaluation of the effectiveness \nof endometrial tissue ablation and depth of necrosis followed. \nPlasma energy ablation of endometrial tissue found to cause \nminimal damage to the ovarian parenchyma [39]. The same \nauthors operated 15 endometrioma ablation using plasma \nenergy and 15 ovarian tissue-sparing cystectomies comparing by \n3D ultrasound ovarian volume and AFC pre- and post-operative \nresults. Those who underwent cystectomy showed a statistically \nsignificant reduction in ovarian volume and AFC when compared \nwith women who underwent ablation using plasma energy. \nThis technique seems to be attractive for reproductive surgery, \nespecially for women with risk for postoperative ovarian reserve \nimpairment, bilateral endometriomas and premature ovarian \nfailure [40].\n\nHow to cite this article: Tanos V, El Akhras S. The Effect of Hemostatic Method on Ovarian Reserve following Endometrioma Excision. Glob J Reprod \nMed. 2017; 1(3): 555564. DOI: 10.19080/GJORM.2017.01.5555640071\nGlobal Journal of Reproductive Medicine\nTable 1: Unilateral Endometrioma Surgery and Haemostasis techniques\nAuthor Refer Study Type Endoma Uni-\nlateral\nHaemostasis \nTechnique Marker Pop Mths P Value\nKitajima et al. \n[30] FS 2011 Prospective\n19   Vs\n13 Bg cysts Stripping only AMH 3 Significantly \nHigher\nLee DY et al. \n[31] Gyn Endoc 2010 Prospective\n13 excisio \n14 Bipolar Oopho-\nrectom\nAMH\nAMH 1, 3\n0.001\n0.002\nZaitoun M et al. \n[35] J Ov Res 2013 Prospective\n61\n60 Lpic  Bipolar\nLmy  suturing\nAMH,\nFSH 6, 8, 12\n0\n0\nBiacchiardi PM \n[25] RBMO 2011 Cohort 43 Lpic striping \nand Bipolar\nAMH, Ovvol\nFSH\n Inhib E2 \nAFC\n3, 9\n0.0001\nUnchanged\nNo SS\nchange\nUrman B [42] RBMO 2013 Cohort 25 Lpic stripping\nAMH,\nAFC 1, 6 0.01\nUncu G et al. \n[16]\nHR\n2013 Cohort\n30\n30 healthy Lpic stripping\nAMH,\nAFC 1, 6\n0.02\n0.01\nErcan CM et al. \n[28]\nEJ OG RB\n2011 Prospective 36 Lpic stripping\nAFC\nDoppler Flow\nAMH 3\nSignificantly low\nSame\nNo SS change\nTsolakides et al. \n[26]\nFS\n2010 PRT 20 Lpic stripping\nLaser CO2\nAMH,\nAFC\nFSH LH E2 6 ,12\n0.026\n0.002\nAsgari  Z et al. \n[37] Arch Gyn 2015 PRT 109 57 bipolLpic\n52 sutLpic\nAMH\nFSH 3\nSignific higher\nSignific higher\nTable 1 summarizes the most recent studies on unilateral \nendometrioma surgery and haemostasis techniques effect on \novarian reserve. In all articles there is significant decrease \nin ovarian reserves, independently what technique has been \nused. Laparoscopic stripping was a common and basic way of \nendometrioma pseudocapsule removal among all studies, being \ndetrimental to healthy ovarian tissue prior to any haemostatic \ntechnique to be followed. Three meta- analysis and systematic \nreviews have been published on Endometrioma Surgery and \nHaemostasis techniques and their effect on ovarian reserves. All \n3 meta-analysis were reviewing the circulating AMH before and \nafter surgery among selected PRCTs [32]. Selected 8 out of 21 \nstudies, polled 237 patients, found a significant post-operative \nfall in circulating AMH, concluding that endometrioma excision \nhas negative impact on ovarian reserves. Somigliana E et al. \n[41] selected 11 out of 47 studies, pooled 344 patients, also \nshowed endometrioma surgery related ovarian reserve damage. \nThey concluded that no further research needed, proposing the \ninvestigation of innovative endometrioma surgical measures.\nAnother meta-analysis of 7RCTs searching for laparoscopic \novarian cystectomy versus fenestration/coagulation or laser \nvaporization for the treatment of endometriomas, demonstrated \nsignificantly lower risk of recurrence of signs and symptoms for \nlaparoscopic cystectomy [RR: 0.29; 95% CI: 0.15-0.55; I²= 0%; \np<0.001] The chance of pregnancy was significantly higher for \ncystectomy compared with fenestration/coagulation (RR: 2.64; \n95% CI: 1.49-4.69; I²= 0%; p<0.001), but not laser vaporization \n(RR: 0.92; 95% CI: 0.30-2.80; p = 0.89). However, there were \ninadequate data for the meta-analysis of ovarian reserve. Authors \nconcluded that further studies are needed to clarify the effect of \nthese surgical approaches on ovarian reserve [15]. \nIn a more recent systematic review and meta-analysis of \nthe haemostatic effect on ovarian reserve after laparoscopic \nendometrioma excision, 4 out of 6 studies were selected and \npooled 213 patients. Haemostasis by suturing the cyst bed was \nunclear whether preserves more healthy ovarian tissue than \nbipolar diathermy coagulation. Moderate quality of evidence \nfavours the application of a haemostatic sealant and low \nquality of evidence favours suturing over bipolar diathermy. \nSealants could be better than bipolar but since it’s human or \nbovine plasma derived product, the risk of viral transmission \nwas of high concern. Authors concluded that bipolar should be \n\nHow to cite this article: Tanos V, El Akhras S. The Effect of Hemostatic Method on Ovarian Reserve following Endometrioma Excision. Glob J Reprod \nMed. 2017; 1(3): 555564. DOI: 10.19080/GJORM.2017.01.5555640072\nGlobal Journal of Reproductive Medicine\ncautiously limited, even avoided [42,43] selected 13 out of 24 \nstudies pooled 597 patients underwent endometrioma surgery, \nconsidered as determining marker of ovarian reserve the pre \nand post-operative AFC. Although lower AFC was found in \naffected ovary after surgery did not reach statistical significance. \nConcluding that AFC is not reduced after surgery.\nDiscussion\nEndometrioma surgery and haemostatic method can \nnegatively affect ovarian reserves. The size of the endometrioma \nand the surgical technique are the most determining factors \npreserving ovarian function. Stripping the endometrioma \npseudocapsule is detrimental for healthy ovarian tissue, reduces \nthe risk of recurrence, however, not appropriate for infertility \npatients undergoing ART . Reproductive surgery should respect \nmaximum possible healthy ovarian tissue increasing the chances \nof good quality and quantity of oocytes. The haemostatic method \nused during endometrioma surgery also affects negatively \novarian reserve. It seems that among all haemostatic modalities, \nthe plasma energy causes the minimum damage to healthy \novarian tissue. Coagulation of the entire endometrioma bed \nshould never be performed. The first operation is probably the \nmost crucial for fertility prognosis. Incomplete and/or unduly \ntraumatic procedures probably, greatly reduce the ovarian \nreserve and chance of spontaneous pregnancy and increase \nthe risk of endometrioma recurrence and /or persistence [10] \nFenestration and laser vaporization of an endometrioma seems \nto minimally destruct the healthy ovarian tissue, offering the \nbest surgery treatment option to infertility patients.\nConclusion\nEndometrioma pseudo-capsule stripping and bipolar \ndiathermy for haemostasis reported a statistically significant \ndecrease inovarian volume, AFC and increase in AMH, being \nmore detrimental to healthy ovarian tissue when compared \nto fenestration andlaser ablation. Endometrioma surgery \ntechnique should be carefully selected especially in infertility \ncases, high risk patients for premature ovarian failure and \nbilateral endometriomas.\nReferences\n1. Gordts S, Campo R, Brosens I (2014) Hysteroscopic diagnosis and \nexcision of myometrial cystic adenomyosis. Gynecol Surg 11(4): 273-\n278.\n2. Yanushpolsky EH, Best CL, Jackson KV, Clarke RN, Barbieri RL, et al. \n(1998) Effects of endometriomas on ooccyte quality, embryo quality, \nand pregnancy rates in in vitro fertilization cycles: a prospective, case-\ncontrolled study. J Assist Reprod Genet 15(4): 193-197.\n3. Suzuki T , Izumi S, Matsubayashi H, Awaji H, Yoshikata K, et al. (2005) \nImpact of Ovarian Endometrioma on Oocytes and Pregnancy Outcome \nin in Vitro Fertilization. Fertility and Sterility 83(4): 908-913.\n4. Kumbak B, Kahraman S, Karlikaya G, Lacin S, Guney A (2008) In vitro \nFertilization in Normoresponder Patients with Endometriomas: \nComparison with Basal Simple Ovarian Cysts. Gynecol Obstet Invest \n65(3): 212-216.\n5. Almog B, Sheizaf B, Shalom-Paz E, Shehata F, Al-Talib A, et al. (2010) \nEffects of excision of ovarian endometrioma on the antral follicle count \nand collected oocytes for in vitro fertilization. Fertil Steril 94(6): 2340-\n2342.\n6. Banerjee SK, Ballard KD, Wright JK (2008) Endometriosis as a marker \nof disease severity. J minim invasive gynecol 15(5): 536-540.\n7. Jenkins S, Olive DL, Haney AF (1986) Endometriosis: pathogenetic \nimplications of the anatomic distribution. Obstet Gynecol 67(3): 335-\n338.\n8. Redwine DB (1999) Ovarian endometriosis: a marker for more \nextensive pelvic and intestinal disease. Fertil Steril 72(2): 310-315.\n9. Busacca M, Vignali M (2003) Ovarian endometriosis: from pathogenesis \nto surgical treatment. Curr Opin Obstet Gynecol 15(4): 321-326.\n10. Vercellini P , Busacca M, Aimi G, Bianchi S, Frontino G, et al. (2002) \nLateral distribution of recurrent ovarian endometriotic cysts. Fertil \nSteril 77(4): 848-849.\n11. Ferrero S, Abbamonte LH, Anserini P , Remorgida V, Ragni N (2005) \nFuture perspectives in the medical treatment of endometriosis. Obstet \nGynecol Surv 60(12): 817-826.\n12. Donnez J, Nisolle-Pochet M, Clerckx-Braun F, Sandow J, Casanas-\nRoux F (1989) Administration of nasal Buserelin as compared with \nsubcutaneous Buserelin implant for endometriosis. Fertil Steril 52(1): \n27-30.\n13. Donnez J, Pirard C, Smets M, Jadoul P , Squifflet J (2004) Surgical \nmanagement of endometriosis. Clin Obstet Gynaecol 18(2): 329-348.\n14. Alborzi S, Momtahan M, Ebrahim Parsanezhad M, Dehbashi S, \nZolghadri J, et al. (2004) A Prospective, Randomized Study Comparing \nLaparoscopic Ovarian Cystectomy Versus Fenestration and Coagulation \nin Patients With Endometriomas. Fertil Steril 82(6): 1633-1637.\n15. Dan H, Limin F (2013) Laparoscopic ovarian cystectomy versus \nfenestration/coagulation or laser vaporization for the treatment of \nendometriomas: a meta-analysis of randomized controlled trials. \nGynecol Obstet Invest 76(2): 75-82.\n16. Uncu G, Kasapoglu I, Ozerkan K, Seyhan A, Oral Yilmaztepe A, et al. \n(2013) Prospective assessment of the impact of endometriomas and \ntheir removal on ovarian reserve and determinants of the rate of \ndecline in ovarian reserve. Hum Reprod 28(8): 2140- 2145.\n17. Chen Y, Pei H, Chang H, Chen H, Wang H, et al. (2014) The impact of \nendometrioma and laparoscopic cystectomy on ovarian reserve and \nthe exploration of related factors assessed by serum anti-Mullerian \nhormone. J Ovarian Res 7: 108.\n18. Ferraretti AP , La Marca A, Fauser BC, Tarlatzis B, Nargund G, et al. \n(2011) ESHRE consensus on the definition of ‘poor response’ to \novarian stimulation for in vitro fertilization: the Bologna criteria. Hum \nReprod 26(7): 1116-1124.\n19. La Marca A, Broekmans FJ, Volpe A, Fauser BC, Macklon NS, et al. (2009) \nAnti-Mullerian hormone (AMH): what do we still need to know? Hum \nReprod 24(9): 2264-2275.\n20. Hansen KR, Hodnett GM, Knowlton N, Craig LB (2011) Correlation of \novarian reserve tests with histologically determined primordial follicle \nnumber. Fertil Steril 95(1): 170-175.\n21. Broer SL, Dólleman M, van Disseldorp J, Broeze KA, Opmeer BC, et \nal. (2013) Prediction of an excessive response in in vitro fertilization \nfrom patient characteristics and ovarian reserve tests and comparison \nin subgroups: an individual patient data meta-analysis. Fertil Steril \n100(2): 420-429.\n22. Broer SL, van Disseldorp J, Broeze KA, Dolleman M, Opmeer BC (2013) \nAdded value of ovarian reserve testing on patient characteristics in the \n\nHow to cite this article: Tanos V, El Akhras S. The Effect of Hemostatic Method on Ovarian Reserve following Endometrioma Excision. Glob J Reprod \nMed. 2017; 1(3): 555564. DOI: 10.19080/GJORM.2017.01.5555640073\nGlobal Journal of Reproductive Medicine\nprediction of ovarian response and ongoing pregnancy: an individual \npatient data approach. Hum Reprod Update 19(1): 26-36.\n23. van Disseldorp J, Lambalk CB, Kwee J, Looman CW, Eijkemans MJ, et \nal. (2010) Comparison of inter- and intra-cycle variability of anti-\nMullerian hormone and antral follicle counts. Hum Reprod 25(1): 221-\n227.\n24. Rustamov O, Smith A, Roberts SA, Yates AP , Fitzgerald C, et al. (2014) \nThe measurement of anti-Müllerian hormone: a critical appraisal. J Clin \nEndocrinol Metab 99(3): 723-732.\n25. Biacchiardi CP , Piane LD, Camanni M, Deltetto F, Delpiano EM, et al. \n(2011) Laparoscopic stripping of endometriomas negatively affects \novarian follicular reserve even if performed by experienced surgeons. \nReprod Biomed Online 23(6): 740-746.\n26. Tsolakidis D, Pados G, Vavilis D, Athanatos D, Tsalikis T , et al. (2010) \nThe impact on ovarian reserve after laparoscopic ovarian cystectomy \nversus three-stage management in patients with endometriomas: a \nprospective randomized study. Fertil Steril 94(1): 71-77.\n27. Hwu YM, Wu FS, Li SH, Sun FJ, Lin MH, et al. (2011) The impact of \nendometrioma and laparoscopic cystectomy on serum anti-Mullerian \nhormone levels. Reprod Biol Endocrinol 9: 80.\n28. Ercan CM, Sakinci M, Duru NK, Alanbay I, Karasahin KE, et al. (2010) \nAntimullerian hormone levels after laparoscopic endometrioma \nstripping surgery. Gynecol Endocrinol 26(6): 468-472.\n29. Hirokawa W, Iwase A, Goto M, Takikawa S, Nagatomo Y, et al. (2011) The \npost-operative decline in serum anti-Mullerian hormone correlates \nwith the bilaterality and severity of endometriosis. Hum Reprod 26(4): \n904-910.\n30. Kitajima M, Khan KN, Hiraki K, Inoue T , Fujishita A, et al. (2011) \nChanges in serum anti-Mullerian hormone levels may predict damage \nto residual normal ovarian tissue after laparoscopic surgery for women \nwith ovarian endometrioma. Fertil Steril 95(8): 2589-2591.\n31. Lee DY, Young Kim N, Jae Kim M, Yoon BK, Choi D (2011) Effects of \nlaparoscopic surgery on serum anti-Mullerian hormone levels in \nreproductive-aged women with endometrioma. Gynecol Endocrinol \n27(10): 733-736.\n32. Raffi F, Metwally M, Amer S (2012) The impact of excision of ovarian \nendometrioma on ovarian reserve: a systematic review and meta-\nanalysis. J Clin Endocrinol Metab 97(9): 3146-3154.\n33. Celik HG, Dogan E, Okyay E, Ulukus C, Saatli B, et al. (2012) Effect of \nlaparoscopic excision of endometriomas on ovarian reserve: serial \nchanges in the serum anti-Mullerian hormone levels. Fertil Steril 97(6): \n1472-1478.\n34. Ferrero S, Scala C, Racca A, Calanni L, Remorgida V, et al. (2015) Second \nsurgery for recurrent unilateral endometriomas and impact on ovarian \nreserve: a case-control study. Fertil Steril 103(5): 1236-1243.\n35. Zaitoun M, Zaitoun M, EL Behery M (2013) Comparing long term \nimpact on ovarian reserve between laparoscopic ovarian cystectomy \nand open laprotomy for ovarian endometrioma. J Ovarian Res 6(1): 76.\n36. Li CZ, Liu B, Wen ZQ, Sun Q (2009) The impact electrocoagulation \non ovarian reserve after laparoscopic excision of ovarian cysts: a \nprospective clinical study of 191 patients. Fertil Steril 92(4): 1428-\n1435.\n37. Asgari Z, Rouholamin S, Hosseini R, Sepidarkish M, Hafizi L, et al. \n(2015) Comparing ovarian reserve after laparoscopic excision of \nendometriotic cysts and hemostasis achieved either by bipolar \ncoagulation or suturing: a randomized clinical trial. Arch Gynecol \nObstet 293(5): 1015-1022.\n38. Kang JH, Kim YS, Lee SH, Kim WY (2015) Comparison of hemostatic \nsealants on ovarian reserve during laparoscopic ovarian cystectomy. \nEur J Obstet Gynecol Reprod Biol 194: 64-67.\n39. Roman H, Pura I, Tarta O, Mokdad C, Auber M, et al. (2011) Vaporization \nof ovarian endometrioma using plasma energy: histologic findings of a \npilot study. Fertil Steril 95(5): 1853-1856.\n40. Roman H, Auber M, Mokdad C, Martin C, Diguet A, et al. (2011) Ovarian \nendometrioma ablation using plasma energy versus cystectomy: a \nstep toward better preservation of the ovarian parenchyma in women \nwishing to conceive. Fertil Steril 96(6): 1396-1400.\n41. Somigliana E, Berlanda N, Benaglia L, Vigano P , Vercellini P , et al. (2012) \nSurgical excision of endometriomas and ovarian reserve: a systematic \nreview on serum antimu¨llerian hormone level modifications. Fertil \nSteril 98(6): 1531-1538.\n42. Ata B, Turkgeldi E, Seyhan A, Urman B (2015) Effect of Hemostatic \nMethod on Ovarian Reserve Following Laparoscopic Endometrioma \nExcision; Comparison of Suture, Hemostatic Sealant, and Bipolar \nDessication. A Systematic Review and Meta-Analysis. J Minim Invasive \nGynecol 22(3): 363-372.\n43. Muzii L, Di Tucci C, Di Feliciantonio M, Marchetti C, Perniola G, et al. \n(2014) The effect of surgery for endometrioma on ovarian reserve \nevaluated by antral follicle count: a systematic review and meta-\nanalysis. Hum Reprod 29(10): 2190-2198.\nYour next submission with Juniper Publishers    \n      will reach you the below assets\n• Quality Editorial service\n• Swift Peer Review\n• Reprints availability\n• E-prints Service\n• Manuscript Podcast for convenient understanding\n• Global attainment for your research\n• Manuscript accessibility in different formats \n         ( Pdf, E-pub, Full Text, Audio) \n• Unceasing customer service\n                       Track the below URL for one-step submission \n                 https://juniperpublishers.com/online-submission.php\nThis work is licensed under Creative\nCommons Attribution 4.0 Licens\nDOI: 10.19080/GJORM.2017.01.555564","source_license":"CC0","license_restricted":false}