Fertility-Enhancing Ovarian Cystectomy

Ovarian cysts are a frequent surgical diagnosis in women of reproductive age. While most ovarian cysts in this age group are benign, a careful preoperative evaluation will identify those who would benefit from surgical intervention and, furthermore, when referral to a gynecologic oncologist may be warranted. The most common cysts encountered in women of reproductive age include simple cysts, serous or mucinous cystadenomas, endometriomas, and mature cystic teratomas. Important aspects of a preoperative evaluation to assist in evaluating for a potentially malignancy ovarian mass include a detailed medical history, physical examination, imaging studies, and laboratory evaluation. Fertility-sparing ovarian cystectomy, typically performed laparoscopically, can be offered to women with benign ovarian cysts who desire future fertility. Prior to ovarian cystectomy, women should be counseled regarding the potential impact on ovarian reserve. Access this chapter Tax calculation will be finalised at checkout Purchases are for personal use only Similar content being viewed by others

National Institutes of Health Consensus Development Conference Statement. Ovarian cancer: screening, treatment, and follow-up. Gynecol Oncol. 1994;55(3 Pt 2):S4–14. Legendre G, Catala L, Moriniere C, Lacoeuille C, Boussion F, Sentilhes L, et al. Relationship between ovarian cysts and infertility: what surgery and when? Fertil Steril. 2014;101(3):608–14. Busacca M, Vignali M. Endometrioma excision and ovarian reserve: a dangerous relation. J Minim Invasive Gynecol. 2009;16(2):142–8. American College of O, Gynecologists' Committee on Practice B-G. Practice Bulletin No. 174: Evaluation and Management of Adnexal Masses. Obstet Gynecol. 2016;128(5):e210–e26. Farghaly SA. Current diagnosis and management of ovarian cysts. Clin Exp Obstet Gynecol. 2014;41(6):609–12. Sokalska A, Timmerman D, Testa AC, Van Holsbeke C, Lissoni AA, Leone FP, et al. Diagnostic accuracy of transvaginal ultrasound examination for assigning a specific diagnosis to adnexal masses. Ultrasound Obstet Gynecol. 2009;34(4):462–70. Castillo G, Alcazar JL, Jurado M. Natural history of sonographically detected simple unilocular adnexal cysts in asymptomatic postmenopausal women. Gynecol Oncol. 2004;92(3):965–9. Ekerhovd E, Wienerroith H, Staudach A, Granberg S. Preoperative assessment of unilocular adnexal cysts by transvaginal ultrasonography: a comparison between ultrasonographic morphologic imaging and histopathologic diagnosis. Am J Obstet Gynecol. 2001;184(2):48–54. Modesitt SC, Pavlik EJ, Ueland FR, DePriest PD, Kryscio RJ, van Nagell JR Jr. Risk of malignancy in unilocular ovarian cystic tumors less than 10 centimeters in diameter. Obstet Gynecol. 2003;102(3):594–9. Guraslan H, Dogan K. Management of unilocular or multilocular cysts more than 5 centimeters in postmenopausal women. Eur J Obstet Gynecol Reprod Biol. 2016;203:40–3. Brun JL, Fritel X, Aubard Y, Borghese B, Bourdel N, Chabbert-Buffet N, et al. Management of presumed benign ovarian tumors: updated French guidelines. Eur J Obstet Gynecol Reprod Biol. 2014;183:52–8. Pavlik EJ, Ueland FR, Miller RW, Ubellacker JM, DeSimone CP, Elder J, et al. Frequency and disposition of ovarian abnormalities followed with serial transvaginal ultrasonography. Obstet Gynecol. 2013;122(2 Pt 1):210–7. Van Holsbeke C, Van Calster B, Guerriero S, Savelli L, Paladini D, Lissoni AA, et al. Endometriomas: their ultrasound characteristics. Ultrasound Obstet Gynecol. 2010;35(6):730–40. Patel MD, Feldstein VA, Lipson SD, Chen DC, Filly RA. Cystic teratomas of the ovary: diagnostic value of sonography. AJR Am J Roentgenol. 1998;171(4):1061–5. Mais V, Guerriero S, Ajossa S, Angiolucci M, Paoletti AM, Melis GB. Transvaginal ultrasonography in the diagnosis of cystic teratoma. Obstet Gynecol. 1995;85(1):48–52. Micco M, Sala E, Lakhman Y, Hricak H, Vargas HA. Role of imaging in the pretreatment evaluation of common gynecological cancers. Womens Health (Lond). 2014;10(3):299–321. Jeong YY, Outwater EK, Kang HK. Imaging evaluation of ovarian masses. Radiographics. 2000;20(5):1445–70. Park SB, Lee JB. MRI features of ovarian cystic lesions. J Magn Reson Imaging. 2014;40(3):503–15. Iraha Y, Okada M, Iraha R, Azama K, Yamashiro T, Tsubakimoto M, et al. CT and MR imaging of gynecologic emergencies. Radiographics. 2017;37(5):1569–86. Kitawaki J, Ishihara H, Koshiba H, Kiyomizu M, Teramoto M, Kitaoka Y, et al. Usefulness and limits of CA-125 in diagnosis of endometriosis without associated ovarian endometriomas. Hum Reprod. 2005;20(7):1999–2003. Suh-Burgmann E, Hung YY, Kinney W. Outcomes from ultrasound follow-up of small complex adnexal masses in women over 50. Am J Obstet Gynecol. 2014;211(6):623 e1–7. Alcazar JL, Diaz L, Florez P, Guerriero S, Jurado M. Intensive training program for ultrasound diagnosis of adnexal masses: protocol and preliminary results. Ultrasound Obstet Gynecol. 2013;42(2):218–23. Alcazar JL, Castillo G, Jurado M, Garcia GL. Is expectant management of sonographically benign adnexal cysts an option in selected asymptomatic premenopausal women? Hum Reprod. 2005;20(11):3231–4. Kinkel K, Lu Y, Mehdizade A, Pelte MF, Hricak H. Indeterminate ovarian mass at US: incremental value of second imaging test for characterization–meta-analysis and Bayesian analysis. Radiology. 2005;236(1):85–94. Hart RJ, Hickey M, Maouris P, Buckett W. Excisional surgery versus ablative surgery for ovarian endometriomata. Cochrane Database Syst Rev. 2008;2:CD004992. Rustamov O, Krishnan M, Roberts SA, Fitzgerald CT. Effect of salpingectomy, ovarian cystectomy and unilateral salpingo-oopherectomy on ovarian reserve. Gynecol Surg. 2016;13:173–8. Ding Y, Yuan Y, Ding J, Chen Y, Zhang X, Hua K. Comprehensive assessment of the impact of laparoscopic ovarian cystectomy on ovarian reserve. J Minim Invasive Gynecol. 2015;22(7):1252–9. Ledger WL. Measurement of antimullerian hormone: not as straightforward as it seems. Fertil Steril. 2014;101(2):339. Chang HJ, Han SH, Lee JR, Jee BC, Lee BI, Suh CS, et al. Impact of laparoscopic cystectomy on ovarian reserve: serial changes of serum anti-Mullerian hormone levels. Fertil Steril. 2010;94(1):343–9. Raffi 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(9):3146–54. Fleming R, Seifer DB, Frattarelli JL, Ruman J. Assessing ovarian response: antral follicle count versus anti-Mullerian hormone. Reprod Biomed Online. 2015;31(4):486–96. Sugita A, Iwase A, Goto M, Nakahara T, Nakamura T, Kondo M, et al. One-year follow-up of serum antimullerian hormone levels in patients with cystectomy: are different sequential changes due to different mechanisms causing damage to the ovarian reserve? Fertil Steril. 2013;100(2):516–22. e3 Exacoustos C, Zupi E, Amadio A, Szabolcs B, De Vivo B, Marconi D, et al. Laparoscopic removal of endometriomas: sonographic evaluation of residual functioning ovarian tissue. Am J Obstet Gynecol. 2004;191(1):68–72. Goodman LR, Goldberg JM, Flyckt RL, Gupta M, Harwalker J, Falcone T. Effect of surgery on ovarian reserve in women with endometriomas, endometriosis and controls. Am J Obstet Gynecol. 2016;215(5):589 e1–6. Vercellini P, Somigliana E, Vigano P, De Matteis S, Barbara G, Fedele L. Post-operative endometriosis recurrence: a plea for prevention based on pathogenetic, epidemiological and clinical evidence. Reprod Biomed Online. 2010;21(2):259–65. Alborzi S, Momtahan M, Parsanezhad ME, Dehbashi S, Zolghadri J, Alborzi S. A prospective, randomized study comparing laparoscopic ovarian cystectomy versus fenestration and coagulation in patients with endometriomas. Fertil Steril. 2004;82(6):1633–7. El Khouly NI, Barr RL, Kim BB, Jeng CJ, Nagarsheth NP, Fishman DA, et al. Comparison of robotic-assisted and conventional laparoscopy in the management of adnexal masses. J Minim Invasive Gynecol. 2014;21(6):1071–4. Morrison J, Lasserson T. Finding time to make the right decision: using frozen section to inform intra-operative management of suspicious ovarian masses. Cochrane Database Syst Rev. 2016;3:ED000109. Beretta P, Franchi M, Ghezzi F, Busacca M, Zupi E, Bolis P. Randomized clinical trial of two laparoscopic treatments of endometriomas: cystectomy versus drainage and coagulation. Fertil Steril. 1998;70(6):1176–80. Alammari R, Lightfoot M, Hur HC. Impact of cystectomy on ovarian reserve: review of the literature. J Minim Invasive Gynecol. 2017;24(2):247–57. Salihoglu KN, Dilbaz B, Cirik DA, Ozelci R, Ozkaya E, Mollamahmutoglu L. Short-term impact of laparoscopic cystectomy on ovarian reserve tests in bilateral and unilateral endometriotic and nonendometriotic cysts. J Minim Invasive Gynecol. 2016;23(5):719–25. Mohamed AA, Al-Hussaini TK, Fathalla MM, El Shamy TT, Abdelaal II, Amer SA. The impact of excision of benign nonendometriotic ovarian cysts on ovarian reserve: a systematic review. Am J Obstet Gynecol. 2016;215(2):169–76. Bernhard LM, Klebba PK, Gray DL, Mutch DG. Predictors of persistence of adnexal masses in pregnancy. Obstet Gynecol. 1999;93(4):585–9. Zanetta G, Mariani E, Lissoni A, Ceruti P, Trio D, Strobelt N, et al. A prospective study of the role of ultrasound in the management of adnexal masses in pregnancy. BJOG. 2003;110(6):578–83. Brady PC, Simpson LL, Lewin SN, Smok D, Lerner JP, D'Alton ME, et al. Safety of conservative management of ovarian masses during pregnancy. J Reprod Med. 2013;58(9–10):377–82. Whitecar MP, Turner S, Higby MK. Adnexal masses in pregnancy: a review of 130 cases undergoing surgical management. Am J Obstet Gynecol. 1999;181(1):19–24. Schmeler KM, Mayo-Smith WW, Peipert JF, Weitzen S, Manuel MD, Gordinier ME. Adnexal masses in pregnancy: surgery compared with observation. Obstet Gynecol. 2005;105(5 Pt 1):1098–103. Platek DN, Henderson CE, Goldberg GL. The management of a persistent adnexal mass in pregnancy. Am J Obstet Gynecol. 1995;173(4):1236–40. Bromley B, Benacerraf B. Adnexal masses during pregnancy: accuracy of sonographic diagnosis and outcome. J Ultrasound Med. 1997;16(7):447–52; quiz 53–4. Sunoo CS, Terada KY, Kamemoto LE, Hale RW. Adnexal masses in pregnancy: occurrence by ethnic group. Obstet Gynecol. 1990;75(1):38–40. Surampudi K, Nirmalan PK, Gundabattula SR, Chandran JB. Management of adnexal masses in pregnancy: our experience from a tertiary referral perinatal centre in South India. Arch Gynecol Obstet. 2015;291(1):53–8. Balci O, Gezginc K, Karatayli R, Acar A, Celik C, Colakoglu MC. Management and outcomes of adnexal masses during pregnancy: a 6-year experience. J Obstet Gynaecol Res. 2008;34(4):524–8. Balthazar U, Steiner AZ, Boggess JF, Gehrig PA. Management of a persistent adnexal mass in pregnancy: what is the ideal surgical approach? J Minim Invasive Gynecol. 2011;18(6):720–5. Amies Oelschlager AM, Gow KW, Morse CB, Lara-Torre E. Management of large ovarian neoplasms in pediatric and adolescent females. J Pediatr Adolesc Gynecol. 2016;29(2):88–94. Gupta B, Guleria K, Suneja A, Vaid NB, Rajaram S, Wadhwa N. Adolescent ovarian masses: a retrospective analysis. J Obstet Gynaecol. 2016;36(4):515–7. Zhang M, Jiang W, Li G, Xu C. Ovarian masses in children and adolescents – an analysis of 521 clinical cases. J Pediatr Adolesc Gynecol. 2014;27(3):e73–7. Papic JC, Finnell SM, Slaven JE, Billmire DF, Rescorla FJ, Leys CM. Predictors of ovarian malignancy in children: overcoming clinical barriers of ovarian preservation. J Pediatr Surg. 2014;49(1):144–7; discussion 7–8. Hermans AJ, Kluivers KB, Wijnen MH, Bulten J, Massuger LF, Coppus SF. Diagnosis and treatment of adnexal masses in children and adolescents. Obstet Gynecol. 2015;125(3):611–5. Wattanayingcharoenchai R, Rattanasiri S, Charakorn C, Attia J, Thakkinstian A. Postoperative hormonal treatment for prevention of endometrioma recurrence after ovarian cystectomy: a systematic review and network meta-analysis. BJOG. 2021;128(1):25–35. Author information Authors and Affiliations Corresponding author Editor information Editors and Affiliations Rights and permissions Copyright information © 2022 The Author(s), under exclusive license to Springer Nature Switzerland AG About this chapter Cite this chapter Gornet, M., Nasab, S., Christianson, M.S. (2022). Fertility-Enhancing Ovarian Cystectomy. In: Lindheim, S.R., Petrozza, J.C. (eds) Reproductive Surgery. Springer, Cham. https://doi.org/10.1007/978-3-031-05240-8_11 Download citation DOI: https://doi.org/10.1007/978-3-031-05240-8_11 Published: Publisher Name: Springer, Cham Print ISBN: 978-3-031-05239-2 Online ISBN: 978-3-031-05240-8 eBook Packages: MedicineMedicine (R0)