Ovarijska rezerva prije i nakon operacije endometrioma

Ovarian reserve is defined as the number of oocytes in the ovary that are available for folliculogenesis. Determining ovarian reserve is important in evaluating and treating infertility, as well as in predicting the outcomes of assisting reproduction methods. There is no test available today that could directly measure number of oocytes. Therefore, in order to estimate the ovarian reserve different tests are being used, including measuring levels of hormones and knowing the physiological grounds for reproduction. Test used in determining the ovarian reserve can be divided in two groups, passive and dynamic. Passive tests include measuring serume levels of FSH, oestradiol, AMH, inhibin-B as well as measuring AFC, ovarian volume and ovarian vascularisation. Dynamic tests are clomiphene citrate challenge test, egsogeneous FSH test and gonadotrophins challenge test. As neither one of this methods is considered to be ideal, the best way to determine ovarian reserve is to combine them. Endometrioma is a benigb, oestrogen dependant cyst, which is strongly related to infertility and to diminished ovarian reserve. There are several suggested mechanisms to explain that correlation, the most significant being damage of the ovary caused by the presence of the endometrioma itself and removal of healthy ovarian tissue during surgery. Many diagnostic methods are being used to determine the presence of endomerioma, but the only confirmation is the pathohistological one. No consensus has been reached regarding endometrioma treatment. However, laparoscopic surgery is the most common way to treat endometiroma. Many studies have shown that the ovarian reserve is undoubtedly diminished following endometrioma surgery. However, studies have also shown that pregnancy rates in such patients do not seem to be significantly lower which is mostly atributed to the normal fucntion of the contralateral ovary.