OC76: Angiogenesis in ovarian endometrioma and pelvic pain

The aim of this investigation was to assess whether a correlation exists between angiogenesis in ovarian endometrioma and the presence of pelvic pain. The amount of blood flow, lowest pulsatility and resistance indexes as assessed by transvaginal power-Doppler ultrasonography, microvascular vessel density (MVD) as assessed by CD-34 immunohistochemical staining in histological specimens, as well as CA-125 and VEGF serum levels were prospectively analyzed in 65 patients (mean age: 33.3 years, ranging from 20 to 49 years) diagnosed as having cystic ovarian endometriosis and scheduled for surgery. Patients were classified into two groups according to clinical complaints: group A (asymptomatic patients or patients presenting mild dysmenorrhea) and group B (severe dysmenorrhea and/or chronic pelvic pain and/or dyspareunia). Five patients were excluded after surgery because no ovarian endometriosis was found in histological analysis. 30 women were included ultimately in each group. Ovarian endometriomas were more frequently vascularized in group B (87%) than in group A (60%) (P = 0.0001). Lowest PI and RI were significantly lower and MVD and CA-125 concentration significantly higher in group B as compared with group A (Table 1). There were no differences in VEGF serum levels. Mean MVD was significantly higher in those moderately-highly-vascularized endometriomas (93.16 + 40.1) as compared with those non-vascular or scanty vascularized endometriomas (55.72 + 29.37) (p = 0.001). No differences in AFSr score and stage as well as the presence of adhesions were found between groups. We conclude that vascularization of ovarian endometriomas evaluated by transvaginal power Doppler and MVD is higher in patients presenting with pelvic pain than in asymptomatic patients. This could be an indicator for endometriosis activity.