INTEGRATED MANAGEMENT OF OVARIAN ENDOMETRIOMAS: PRE- AND POST-SURGICAL USE OF DIENOGEST

AIM: to evaluate the efficacy of an integrated management approach for ovarian endometriomas using Dienogest administered both before and after laparoscopic cyst enucleation in women with infertility. MATERIALS AND METHODS: The prospective, comparative clinical trial included 44 patients aged 18-35 years with ovarian endometriomas and infertility. Patients were randomly divided into two groups: the study group (20 participants) received Dienogest for six months before and after laparoscopic cyst enucleation, while the control group (24 participants) underwent laparoscopic cyst enucleation without additional hormonal treatment. Outcomes measured included: cyst size (before treatment and after six months of Dienogest administration in the study group), serum levels of anti-Müllerian hormone (AMH), antral follicle count (AFC) in both groups (before and six months after surgery), pregnancy rates, and recurrence rates of endometriomas within a 1-year follow-up. RESULTS: Study Group: Dienogest treatment resulted in a significant reduction in cyst size before surgery. AFC and AMH levels remained stable before and after surgery. At the 1-year follow-up, 13 participants (65%) achieved pregnancy, and endometrioma recurrence was observed in 3 participants (15%). CONTROL GROUP: Six months post-surgery, AFC and AMH levels were significantly lower than pre-surgery levels. During the follow-up, 7 participants (29.2%) achieved pregnancy, and endometrioma recurrence was noted in 19 participants (79.2%). CONCLUSION: The integrated management approach using Dienogest administered both before and after laparoscopic cyst enucleation has proven to be effective in improving reproductive outcomes and reducing recurrence rates of ovarian endometriomas in women with infertility.