Restoring Function with Neonatal Fluid Allograft in Cases of Endometriosis or Other Ovarian Destructive Conditions [23Q]

INTRODUCTION: Endometriosis, in particular endometriomas, can cause impairments in folliculogenesis or other damage to ovarian tissue in patients trying to achieve pregnancy. These patients are often tested for levels of anti-Mullerian hormone (AMH), follicle stimulating hormone, and antral follicle counts to assess “ovarian reserve” and fertility potential. Here we present use of a fluid neonatal allograft in laparoscopy to improve AMH levels and chances of conception. The allograft has a multi-specialty indication for the correction of soft tissue defects, and current research suggests it may have the potential to aid in restoration of ovarian function. METHODS: Three patients with moderate to severe endometriosis underwent laparoscopic resection of endometriosis and ovariolysis. Patients’ fallopian tubes were patent and fimbria intact. An amniotic fluid allograft was injected in the areas of tissue defects. Patients had blood work tested pre-operatively and 1 and 3mo post-operatively. Ultrasound was also performed pre- and post-operatively to assess antral follicle count in the beginning and middle of menstruation cycle. RESULTS: One patient had a rise of AMH level from 0.5ng/ml (pre-op) to 1.5ng/ml (post-op). This patient also had mature follicle on day 12 of her cycle whereas pre-operatively there was no evidence of folliculogenesis by ultrasound even with Clomid therapy. Assessments of two other patients are on-going. CONCLUSION: Preliminary findings show an improvement in AMH levels and folliculogenesis after ovarian treatment with a neonatal-derived fluid allograft, suggesting that this treatment may aid in restoration of ovarian function and achievement of a successful pregnancy.